Inspection on 08/04/05 for Lennox Lodge

This inspection was carried out on 8th April 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

Lennox Lodge 03/04/08

Lennox Lodge 26/04/07

Lennox Lodge 29/06/06

Lennox Lodge 27/09/05

Lennox Lodge 21/12/04

Lennox Lodge 06/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Lennox Lodge 37 The Highlands Bexhill on Sea East Sussex TN39 5HL Lead Inspector Niki Palmer Unannounced 8 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lennox Lodge Version 1.10 Page 3 SERVICE INFORMATION Name of service Lennox Lodge Address 37 The Highlands Bexhill on Sea East Sussex TN39 5HL 01424 222966 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Guy Haddow Ms Mandy Donno (Acting Manager) Care Home 19 Category(ies) of Mental disorder (MD) 19 registration, with number of places Lennox Lodge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The maximum service users to be accommodated is nineteen (19) 2. Service users should be aged fifty five (55) years or over on admission 3. Only service users who have a diagnosed past or present mental illness are to be accommodated 4. The registration excludes service users who have a learning disability or a dementia type illness. Date of last inspection 21 December 2004 Brief Description of the Service: Lennox Lodge is a care home registered to provide accommodation for up to nineteen residents aged 55 or over on admission who have a mental disorder. Lennox Lodge is a large detached property situated in the residential area of The Highlands, approximately three and a half miles north of Bexhill-on-Sea. Accommodation is provided over three floors with level access only to the front of the building. The home consists of 11 single bedrooms, 5 of which are ensuite and four double bedrooms, without en-suite facililities. A planning application has been submitted to the Council in order to create two additional bedrooms on the first floor and four additional rooms to the top floor. The building plans do not allow for a passenger lift, which would limit access to the building by those with mobility needs. The nearest village Sidley, is approximately half a mile away, which can be accessed via the local bus service. Lennox Lodge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between on a Friday between 10.30am and 4pm. The inspection found that of the 21 National Minimum Standards inspected, that only 6 of these standards had been met, with 1 standard [6] not applicable. Major shortfalls were identified in 9 of the assessed standards. The inspection began with discussions with the deputy manager and registered provider of the care home in respect of progress made since the last inspection, followed by the examination of care and staff records. In order to gather evidence on how the home is performing, in depth discussions took place with 8 residents; most of the residents were at home on the day of the inspection. This inspection included a detailed tour of the premises and its facilities. What the service does well: What has improved since the last inspection? What they could do better: This inspection highlighted some serious concerns. The systems in place for the administration of medication are especially concerning as these were raised at the last inspection, and the home recently had an issue whereby a controlled drug went missing. They have failed to improve their procedures, and errors continue to be made. Residents complain of being bored and wish for a variety of things to do both within and outside of the home. The home needs to consult with residents around their wishes and personal choices and take these in to consideration in the day-to-day running of the home. The environment and general décor is quite poor in some areas and in need of a clear maintenance programme albeit that residents bedrooms were found to be well maintained and in good order. The arrangements for the recruitment of staff is also concerning. The home needs to tighten up its procedures to ensure that Lennox Lodge Version 1.10 Page 6 staff are only employed on the basis of adequate identity and police checks to ensure the welfare of residents and quality of care is not compromised and exposing residents to risk. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Lennox Lodge Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Lennox Lodge Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 5 and 6. The pre-assessment document does not cover all aspects of specific care needs. Arrangements are in place for residents and their families to visit the home prior to admission. EVIDENCE: The statement of purpose was last updated in April 2004 however it does not accurately reflect the current residents accommodated as stated on the conditions of registration, as there is one resident accommodated with a learning disability and another with dementia. Two pre-assessment documents were seen for the most recent admissions to the home, which had been completed by the acting home manager. Thorough details of their physical health and social care needs had been included however, detailed histories of their mental health needs had not been recorded, which is imperative to this care home. Both residents had been invited to visit the home prior to admission. Emergency admissions are avoided where possible. Due to the nature of the residents accommodated and layout of the home, intermediate care is not offered, and therefore not applicable to this standard. Lennox Lodge Version 1.10 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9. The arrangements for planning care in this home are good, ensuring that health, personal and social care needs of residents are met. However, the systems for the handling, storage and administration of medication are extremely poor, potentially placing residents at risk. EVIDENCE: Following admission a post assessment form is completed by the acting manager in order to help her to review and formulate the care plans, two of which were seen on the day of inspection. All care plans seen were found to be very detailed and personalised regarding residents’ physical, psychological and social care needs and there was clear evidence that the home review all care plans on a monthly basis. In addition, each resident had a detailed plan of care in place that can be transferred with the individual should they require an admission to hospital. Despite a requirement being made at the last inspection, and a recent medication error whereby a controlled drug went missing, the home has failed to tighten up its procedures and ensure that all designated staff are competent Lennox Lodge Version 1.10 Page 10 to administer medication as prescribed. A number of errors were found on the medication administration records, for example medication that had been given had not been signed for on numerous occasions, and in one instance a member of staff had signed for medication that had been forgotten and was still in the medicine cupboard from the day before. Regarding the recording of controlled drugs, it was not clear from their records as to the reasons why on some occasions it had been omitted. In addition, the arrangements for the storage of these drugs needs to be reviewed as they are currently being stored in a filing cabinet. An immediate requirement was made for the home to address its medication policies and procedures and to liaise with a pharmacy inspector. Lennox Lodge Version 1.10 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 14. Only limited progress has been made in addressing residents’ interests and leisure activities. Residents’ views are sought from time to time but they do not perceive them as having much effect in changing home the home is run. EVIDENCE: All of the care plans seen clearly identified residents’ interests, leisure and social activities, however on the day of the inspection all but two of the residents were at home; the majority of which were seated in the main lounge area watching the television. All of the residents spoken to stated that they often felt bored within the home and wished for more outside activities such as a trip to the local pub and shops. There was no recorded evidence of activities having taking place however, the registered provider stated that the home provide motivation sessions on a monthly basis. Although there are policies and procedures in place to support residents in exercising their personal choice, many of the residents spoken to stated they often felt as though they were not listened to by staff. For example, some of the residents seated in the living area complained that the room felt cold and draughty. When it was suggested that they close the door, the inspector was informed that they were not allowed to as staff prefer the door to be open at all times. Lennox Lodge Version 1.10 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 and 18. The home has adequate procedures in place to ensure that residents are protected from harm, neglect and abuse. EVIDENCE: External advocacy services are available to all residents on an individual basis; in addition many of the residents have support from either their families, social worker or solicitor. All residents are encouraged to exercise their legal rights and participate in the election process via the postal voting system. The home has a detailed adult protection and whistle blowing policy in place. There have been no reported incidents of harm, neglect or abuse since the last inspection. Lennox Lodge Version 1.10 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24, 25 and 26. Residents’ bedrooms are well maintained, comfortable and homely, however little improvement through maintenance has been made to communal areas since the last inspection. The home therefore does not present throughout as a homely and comfortable environment. EVIDENCE: On the day of inspection, some areas of the home were found to be in need of attention. Tiles in the ground floor bathroom were missing around the toilet area, potentially placing residents at risk. In addition, wallpaper was peeling from corridor walls, and lamp shades were missing. One of the communal toilet doors was locked shut to prevent residents from using it on the first floor, as one resident has taken to blocking it with toilet paper. The home has a boiler installed on the top floor with unprotected pipework; this has not been addressed since the last inspection. Although the home has submitted a planning application to the Council, for an extension to create six additional bedrooms over the first and second floor they Lennox Lodge Version 1.10 Page 14 do not allow for a passenger lift, which would limit access to the building by those with mobility needs. All of the bedrooms seen were found to be clean, comfortable and personalised throughout with the exception of one bedroom on the third floor; strong and unpleasant odours were noted. Lennox Lodge Version 1.10 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. The standard of vetting and recruitment practices is poor, potentially placing residents at risk. The staff have a good understanding of the residents’ support needs. EVIDENCE: The home currently has four full-time vacancies. Bank and agency staff are used where necessary at key times. On a day-to-day basis there are usually two carers and a cook on duty on both the early and late shift. At the previous inspection a cleaner was employed for three days a week, however care staff are now responsible for the daily cleaning duties of the home, which takes them away from spending time with the residents. Although many of the care staff are experienced in working with people in a care setting and have a good understanding of the residents’ needs, the home has not provided any training to staff as required in the previous inspection report around working with individuals with specific assessed mental health needs. Of the twelve staff recruitment files inspected, only one was complete with the necessary documentation required under schedule 2 of the regulations. POVA First checks / CRB had not been applied for, two written references had not been obtained and the vast majority of files did not contain any form of identification. An immediate requirement was issued at the time of the inspection. Lennox Lodge Version 1.10 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36 and 38. Induction and supervision of staff is very good within this home. The fact that the home continues to wedge open fire doors is placing its residents and staff at risk. EVIDENCE: The acting manager has been in post for almost one year, however she has yet to complete the documentation required for registration by the Commission for Social Care Inspection. All of the residents and staff spoken to during the inspection spoke highly and positively of her leadership skills. The vast majority of residents have appointed external appointees and/or family members for handling their monies, however the acting manager is currently the named individual for one specific resident regarding financial management. This should be reviewed. Lennox Lodge Version 1.10 Page 17 From the records inspected all new staff are given a thorough induction, which is documented and signed by the person and the acting manager. In addition, recorded supervision structures are in place. It was concerning to note that many fire doors continued to be wedged open in the corridors and bedrooms downstairs. It was a requirement of the previous inspection that these should be removed immediately, risk assessments carried out and the appropriate action taken. In addition, potentially hazardous substances were found in two of the bathrooms, resulting in an immediate requirement being made at the time of the inspection. Lennox Lodge Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 1 x 1 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 x COMPLAINTS AND PROTECTION 1 x x x x 3 1 2 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x 3 3 2 x x x 2 3 x 1 Lennox Lodge Version 1.10 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4(1)(a-c) & schedule1 14(1)(c) Requirement Variations for two of the residents must be applied for and included within the homes statement of purpose. Residents should only be admitted to the home once a thorough assessment of their mental health needs (past and present) has been documented. The homes policies and procedures regarding the administration of medicines, including controlled drugs must be reviewed immediately (this was an immediate requirement from the previous inspection). Advice from a pharmacy inspector must be sought. Residents must have access to and be supported to choose from a range of appropriate leisure activities [THIS IS OUTSTANDING FROM THE TWO PREVIOUS INSPECTIONS]. The home must ensure that residents are supported to exercise personal choice and autonomy. All accessible areas must be safe, well-maintained and clean throughout [THIS IS Version 1.10 Timescale for action 30/06/05 2. OP3 With immediate effect. 21/12/04 with immediate effect. 3. OP9 13(2) (4)(c)17 (1)(a) & schedule3 4. OP12 16(2)(m) (n) 12(3) 30/06/04 extended to 30/06/05 With immediate effect. 21/12/04 With immediate Page 20 5. OP14 12(2)(3) 6. OP19 13(4)(a) (c) 23 (2) Lennox Lodge 7. OP25 13(4)(a) (c) 8. 9. OP26 OP27 12(1)(a) 16(1)(2) (k) 18(1)(a) 10. OP29 19 & schedule 2 11. OP30 18(1)(c) (i) 12. OP31 9(2) 13. 14. OP35 OP38 20(1)(a) (b) 23(4) (a-e) 15. OP38 13(4)(a) (c) OUTSTANDING FROM THE PREVIOUS INSPECTION]. That all pipework and boilers accessible to residents are covered appropriately [THIS IS OUTSTANDING FROM THE TWO PREVIOUS INSPECTIONS]. The home must be kept free from offensive odours throughout. The home must review its staffing levels to ensure that at all times such numbers are appropriate for the health and welfare of residents. The home must ensure that all employees are subject to thorough recruitment checks under schedule 2 of the regulations [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION]. That the homes training programme includes training around working with people with specific mental health needs [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION]. That an application is submitted to the CSCI for a registered manager [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION]. Safeguards must be in place to protect the financial welfare of residents. All wedged open fire doors must be risk assessed and appropriate action taken [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION]. That all hazardous materials are stored in a locked cupboard. effect. 01/03/05 extended to 30/06/05 With immediate effect. 30/06/05 21/12/04 extended to 30/06/05 21/12/04 extended to 30/06/06 30/07/05 With immediate effect. 21/12/04 extended to 30/06/05 With immediate effect. Lennox Lodge Version 1.10 Page 21 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 Good Practice Recommendations Lennox Lodge Version 1.10 Page 22 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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