Inspection on 03/10/05 for Latham Lodge Nursing and Residential Care Home

This inspection was carried out on 3rd October 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.

Other inspections for this house

Latham Lodge Nursing and... 19/12/08

Latham Lodge Nursing and... 30/06/08

Latham Lodge Nursing and... 10/04/06

Latham Lodge Nursing and... 01/06/05

Latham Lodge Nursing and... 19/08/04

Latham Lodge Nursing and... 13/04/04

Similar services:

St Vincents

The Cotswold Home

Winton House

Newbeech House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Latham Lodge Nursing and Residential Care Home 137 - 139 Stakes Road Purbrook Hampshire PO7 5PD Lead Inspector Val Sevier Unannounced Inspection 3rd October 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 Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Latham Lodge Nursing and Residential Care Home 137 - 139 Stakes Road Purbrook Hampshire PO7 5PD Address 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) (023) 92 254175 (023) 92 262281 Latham Lodge Limited Mrs Francis Janet Hill Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (8), Physical disability of places over 65 years of age (40), Terminally ill (8), Terminally ill over 65 years of age (20) Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users admitted in PD and TI categories cannot be admitted under the age of 55 years Service Users may be in receipt of Personal care and / or Nursing care Date of last inspection 1st June 2005 Brief Description of the Service: Latham Lodge is registered as a care home where nursing care can be provided for up to forty people in the categories of old age, terminal illness or physical disability. The home can also admit up to eight people above the age of 55 in the category of terminal illness and physical disability. The home has twenty-six single rooms, of which twelve have ensuite bathrooms and seven shared rooms, one of which is ensuite. The home is located in a residential area and the building is on two floors with a shaft lift to access the first floor. The home has a large car park at the front of the building and a garden accessible to the residents at the rear. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was the second statutory inspection of the year. The visit looked at standards not seen last time and at the action that was required from the last visit in June. The inspectors looked at 5 care plans; spoke with 9 residents and several staff members. The regional manager and head of care assisted throughout the visit, all staff were helpful. The regional manager explained that a new manager had been appointed and it was hoped that they would join Latham lodge in a couple of months. Feedback was given throughout the visit and at the end; an immediate request for action to return unwanted medication was made. Discussion was had with the regional manager in relation to the needs the home is registered to care for and the needs that some residents had in relation to mental health. What the service does well: What has improved since the last inspection? Residents spoken with said that the quality of the meals had improved since the last inspection. The cook has been at the home a month and is working on new menus in consultation with the residents. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.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. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5. Standard 6 is not applicable at this home. The home has an understanding of residents needs using the assessment process, however further work is needed to ensure that all identified needs are able to be met. There is sufficient information for prospective residents and families to make an informed choice about the home. EVIDENCE: The inspector looked at 5 care plans and each individual had had an assessment prior to moving to the home. The assessments contain information about the needs of the individuals. However it was observed that the information gained through the assessment had not been used to complete the care plans when the identified need was mental health. At the time of the inspection the home was working with social services and health to find an alternative home, one that was more able to meet the identified needs. The pre admission assessment had been done however there seemed to be a lack of information about the disruptive behaviour the person could display on a regular basis, although this had been requested from social Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 9 services, it had not been supplied. The regional manager agreed to keep the CSCI informed about this matter, since the inspection this situation has been resolved. Residents spoken with said that they liked the home and felt looked after. Information is available about the home to give prospective residents and their families or representatives and informed choice. Visits to the home are encouraged and due to the frailty of the residents this is often their family. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.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, 9 and 10 The care plans do not always identify all needs and have not been revised as needs change; this could potentially place residents at risk of not receiving appropriate care. The systems for the administration of medication are poor and could potentially place residents at risk. Staff were seen to behave appropriately with residents with some identification of emotional and physical needs. EVIDENCE: The inspector viewed five care plans in conjunction with a sample of medication records and other health monitoring tools used at the home. When looking at the care plans with the pre admission assessments it was seen that needs such as dementia, confusion, psychosis and depression had been identified and that other professionals had been involved with some individuals for example psychiatric services prior to moving to the home. However there was no evidence that these needs were now being met with no care plans and no action for staff. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 11 There were residents receiving care for pressure sores and skin flaps caused it would seem from records, through moving and handling. The records were variable in the planning and implementation of care although the district nurse had been involved in one case, in one case the last entry was 30/08/05 with the wound dressing to be changed as necessary. Documents were not dated such as the photos of wounds so progress could not be mapped. There was not always evidence in the daily notes that that care for wounds had been carried out. Daily records were kept and the inspectors were able to have an idea of the lives of the individuals. The medication was seen as there had been action asked for at the last visit. There were several gaps (20) in the administration records where there was no indication of whether medication had been given or not. There was no evidence in either these records or the daily notes of reasons why medication that was prescribed had not been given or the effect of an ‘as needed’ medication. The head of care commented that she planned to look at medication its storage, recording and ordering in depth. There are three residents who self medicate at the home however when the inspector spoke to the staff there was little understanding of how this worked apart from they ordered the medications and gave it to the individuals, there was no audit trail in place for the protection of the nurses and residents. The assessments for these individuals had last been carried out in November 2004 and were due to have been reviewed in May and were not. Since July 2005 the method by which the home disposal of unwanted medication changed with the local chemist no longer doing this for the home. However no alterative method has been put in place and as a consequence the home has excessive amounts of medication that needs to be removed. The inspector left a request for action to take place for this within two weeks of the visit. The inspectors were able to discuss all these concerns with the regional manager and head of care. Staff were observed speaking and assisting the residents with dignity and respect. Affection was given appropriately to those residents who sought it. It had been seen on care plans that the preferred choice of name had been recorded and staff were heard to speak to residents by the name they wished. These issues will be monitored at the next visit to the home. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.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): 13, 14 and 15 Links with the community are good and support users social opportunities. Staff enable residents to make choices about their lives. Residents receive a balanced diet and at times convenient to them. EVIDENCE: Resident’s spoken with said that thy felt they had choices in their lives where possible about when they got up or went to bed. The care plans seen had a night plan which was the only one handwritten and seemed very individualised with preferred times of getting up and going to bed and a persons routine recorded. The residents said they felt able to express a decision about life in the home and that things were as expected. There had been some concern expressed by the residents at the last visit about the food. The inspectors spoke with the chef who has been at the home about a month and who has worked in care homes before. She is aware of the thoughts of the residents and has started speaking with them about the types of meals they would like. Choice still seems to be an issue for some and not knowing what they going to get on a daily basis. One lady is happy that she can have a vegetarian meal. The regional manager also confirmed that the chef is working on the menus and that this will coincide with the recording of choices and help not only with the budgeting but also for the nurses to assess resident’s nutritional intake. The dining room at the home has 4 tables for use Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 13 and many residents choose to eat their meals in their own rooms or in the lounge area. Residents stated that hot and cold drinks are available throughout the day and night on request. The inspector observed staff supporting service users appropriately at lunchtime on the day of the inspection. These issues will be monitored at the next visit to the home. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.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 and 18 It would seem the staff in conjunction with the head of care have worked at establishing a sense of openness at the home so that relatives and residents can voice their concerns. It would seem when talking to staff that they also feel that they can voice concerns especially regarding the care of the residents. EVIDENCE: There has been one complaint made to the home since the last inspection and none to either the CSCI. However there was no evidence as to how the complaint was investigated and resolved just a record that it was unsubstantiated. Residents were aware of how to complain and said they felt comfortable in speaking with the manager or deputy about any issues. There have been no allegations regarding adult protection at the home. The manager undertakes training the staff in this area, and staff spoken with were aware of the whistle blowing policy and the training. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.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): 20, 21, 22, 23, 24, 25 and 26 Residents have access to comfortable indoor communal facilities, however access to the garden is restricted. Residents live in a reasonably maintained environment. Equipment for staff to care for resident’s laundry should be safe and available for use. EVIDENCE: A tour of the building was undertaken and communal areas were well lit and all areas were well furnished. The inspection took place in the morning and the inspectors found that there were a number of items of breakfast crockery around the home and staff were trying to mask some unpleasant odours with air fresheners. The rear garden has been landscaped to a high standard and there are sitting areas for residents, access is via the main lounge through double doors which are marked “Fire Exit” and these doors are opened by a push bar, once outside residents would need to knock on the doors to get back into the lounge. It is recommended that patio type doors be provided; these would give easier entry and exit from the garden and would still provide a means of exiting the building in the event of a fire. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 16 There were sufficient lavatories and washing facilities in the home and water temperatures were maintained at a suitable level. Specialist equipment is provided throughout the home with handrails, hoists and wheelchairs available to assist residents. It was noted that there were no dedicated storage areas for hoists or wheelchairs and staff must be made aware of the potential dangers from these items being left around the home. There are call systems in all bedrooms, bathrooms and toilets and also in communal areas and these can only be turned off at source. There are a number of monitoring points around the home and these displayed the location where the assistance was needed, the inspector monitored a number of calls and these were all responded to in good time. The inspector was able to visit a number of residents rooms and these were personalised and contained the required furniture and fittings, a number of the rooms had hospital type beds while others has divan type beds. Residents spoken to were happy with their own rooms and the communal areas in the home. The home employs a maintenance man to repair any defects and there is a maintenance plan for the home and this is being followed. The home has a laundry and has 2 dedicated laundry staff, there are 2 industrial washing machines with sluice programmes, and any soiled laundry is brought down in red bags so that it is clearly identified. There is currently one industrial tumble drier and this is backed up by a small domestic tumble drier, one large industrial drier has been broken for over a year and there is a replacement in the laundry room but this has not yet been installed. There is a rotary iron for sheets but this has been broken since August 05. Hand washing facilities are available but there is no sink to enable hand washing to be carried out, at present the laundry staff use a bucket to had wash certain items of residents clothing. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.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): 27, 29, 30 Resident’s needs are met by a staff team in sufficient numbers and with a mix of skills and they are trained and competent to do their jobs. Residents are protected by the homes recruitment policies and practice. EVIDENCE: The homes staffing rota showed that between 8.00am and 2.00pm, 2 nurses f are on duty with an additional 7 care staff, between 2.00pm and 5.00pm, 1 nurse is on duty with 6 care staff and between 8.00pm and 8.00am there is 1 nurse with 3 care staff. The care staff are supported by laundry, domestic and catering staff and in addition the homes manager is available. Residents spoken with stated that there were always staff around and that if they used their alarm call system, staff arrived in good time. The home has policies and procedures in place with regard to recruitment and staff recruitment records were inspected for 3 staff members and those seen contained all the required information including 2 references and a record of CRB checks. The home has an “in house” induction procedure together with a Skills Council induction and foundation programme. Staff have received training in food hygiene, first aid, infection control, moving and handling, fire safety, principles of care, wound care and abuse. Some staff training records did not contain dates when training was carried out and it was recommended that all training be dated to enable refresher training to be provided at suitable intervals. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 18 Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38. Changes of management means the home cannot demonstrate the service is well run and managed. This is affecting the care offered and the well being of the residents. There is concern that the lack of leadership particularly on the nursing side will lead to a deterioration of service for the residents. The health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: There is currently no registered manager at the home, although one has been appointed and it is hoped that they will start at Latham in a couple of months. A head of care has been appointed following a restructuring of staff since the last inspection. This person will support the manager in managing the caring Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 20 and nursing side of the service. The regional manager is supporting the head of care at the moment in the management of the home. The regional manager is aware that there is potential for areas of concern in the care at the home and will advise the CSCI of the identified areas and action they feel is needed. Consequently supervision has not taken place regularly. Staff meetings have been held which staff felt was helpful in keeping them informed about issues at the home. The home looks after one person’s personal money only. The inspector looked at the homes fire records and these showed that appropriate testing and monitoring had been carried out within the specified timescales. Certificates were seen for the annual tests of fire fighting equipment, fire alarms, boilers, electrical equipment hoists and for the shaft lift and these were all in date. Certificates and testing records were kept in a health and safety log, however it was difficult to find some of the certificates as these were kept alongside old certificates. It was recommended that the most up to date certificates and records be kept at the front of the log to make auditing and checking easier. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 21 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 X 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 X 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X 3 X 2 X 3 Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 22 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 4 Regulation 12(1a) 18(1c) Requirement Timescale for action 15/12/05 15/12/05 2 7 3 4 8 9 5 6 26 26 The registered person must ensure that the staff are able to meet the identified needs of the residents. 15 Sch3 The registered person must 17(1)(a) ensure that care plans are in place and that they provide staff with information to meet the resident’s needs. 12 (1), The registered person must 17(1) Sch ensure that the health needs of 3 residents are met. 13(2)Sch3 The registered person must (K)14(2) ensure that policies and records for the administration, storage and ordering of medication is followed, reminding the staff of their registration with the Nursing and Midwifery Council. (The previous date of 1/06/05 has not been met) 16(2)(k) The registered person must ensure that the home is odour free. 16(2)(e) The registered person must (j) ensure that there is sufficient equipment to care for the resident’s laundry and that this equipment is maintained. DS0000011509.V252141.R01.S.doc 15/12/05 03/11/05 31/10/05 31/10/05 Latham Lodge Nursing and Residential Care Home Version 5.0 Page 23 7 26 13(4c) 16(1) The registered person must ensure that appropriate hand washing facilities are available for laundry staff. 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard 20 30 38 Good Practice Recommendations It is recommended that patio type doors be provided to enable easier access into the garden for residents. It is recommended that all training be dated to enable refresher training to be provided at suitable intervals. It is recommended that the most up to date certificates and records be kept at the front of the log to make auditing and checking easier. Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Latham Lodge Nursing and Residential Care Home DS0000011509.V252141.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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