Inspection on 12/05/05 for Linda Lodge

This inspection was carried out on 12th May 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

Linda Lodge 24/01/08

Linda Lodge 07/06/07

Linda Lodge 05/10/06

Linda Lodge 17/01/06

Linda Lodge 25/01/05

Linda Lodge 05/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Linda Lodge 91 Worcester Road Sutton Surrey SM2 6QZ Lead Inspector David Pennells Announced 12 & 13 May 2005, 09:40 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. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Linda Lodge Address 91 Worcester Road, Sutton, Surrey, SM2 6QZ 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) 020 8642 0343 not applicable not applicable Ms Tina Freed Mrs Lynda Penfold Care Home 26 Category(ies) of Mental disorder registration, with number Old age of places Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Those in the mental health category to be aged 55 and over. One service user in the physical disability category may reside at the home for as long as their needs can be fully met. Date of last inspection 25/01/05 Brief Description of the Service: Linda Lodge is a large extended family house situated on the west side of Sutton, being roughly equidistant from Cheam Village. The house sits on a corner plot, a short walk to a bus stop that allows access into Sutton town centre within a few minutes. The surrounding environment is a pleasantly tree’d suburban ‘Surrey’ residential area. The entrance to the house is a pleasant space – where the manager has her bureau, and occasional chairs provide for those ‘passing through’ to sit and watch the world coming and going - access to the main staircase and kitchen is also through this area. The home offers single bedroom accommodation to twenty-two of the total maximum of twenty-six service users, half of whom are in the elderly category, and half of whom are over the age of 55 and have some form of past or present mental health difficulty. The two double rooms continue to be occupied by a single person and by a couple. Communal space is pleasant, and provides a choice of smoking and nonsmoking lounges, the latter adjoining the separate dining area. A pleasant patio area with good garden furniture is provided off the smoking lounge. The home still has to address the need for certain aspects for fulfilling basic rerquirements within the ‘old age’ category of the home: the provision of a passenger lift and equipment such as a sluice-cycle washing machine continue to remain outstanding requirements. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was an announced visit ranging over two days totalling thirteen hours of engagement - with the management, staff, service users or relatives. During this time the inspector was able to spend a significant time listening to the service users and also observing the general running of the home. The inspector dined – at lunchtime - with a different set of service users, on each day of the visit. The inspector is grateful to the service users, staff and management /proprietors of the home for their welcome, time and hospitality. “I’m looked after as well as I could ask for” - thus stated one of the male service users at Linda Lodge – and indeed, this seems to be the story that is heard repeatedly particularly from service users – but also from relatives and friends – who really value the friendly and homely environment at the home. The inspector was pleased to note the progressive advances the proprietors have made in addressing the inspection report requirements and recommendation from the last visit; previously seventeen requirements and four recommendations were made; this has now reduced to ten requirements and seven recommendations – respectively nine and four carried forward. Principally, the focus of these outstanding issues relate to staff support and training, to recording, and policies/procedures, and to some principal premises issues. What the service does well: The service provides a warm and comfortable, generally safe environment for service users to go about their business in an independent and dignified way. The ‘younger’ age range of the mental health client group at the home anchors the service user group in the ‘young at heart’ (at least) age bracket – encouraging self-help and communication. Although some service users are of significant old age, most are able to contribute an opinion or observation about life at the home and beyond. Rooms provided are individual and well kept, being personalised as well as well decorated. Communal space is pleasant - though the inspector does, now, challenge the proprietors to designate the home’s entrance hallway – which is used as a communal meeting point – a ‘non-smoking’ area. Staff and management provide an unobtrusive service of care and attention to the service user group, this being evidenced by a number of compliments from service users, talking about their own particular situations. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? 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. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 6. Prospective service users have access to some information, but could benefit from a more comprehensive set of information provided to them before and at the point of admission through a fuller Statement of Purpose and Service User Guide. Service users are provided with a contract stating terms and conditions of occupancy – but this document would benefit from more specific detail to make clear specific conditions relating to residence at this particular care home. Service users can be sure that - prior to and on admission - sufficient information is gathered to ensure a suitable service can be provided at the home. The staff training profile does not at present necessarily assure a potential service user who has a mental health diagnosis that the home is sufficiently ‘skilled up’ - through having a staff team with adequate mental health training / background. Linda Lodge does not provide intermediate care and therefore this standard is not inspected or assessed. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 9 EVIDENCE: An outstanding requirement remains: the home’s Statement of Purpose and Service User Guide has yet to be amended as required at the last inspection visit. It must be rationalised to clearly present as the two documents required by Regulations 4 and 5 - and more fully described in those Regulations, the associated Schedule 1, and revised Standards 1.1 and 1.2. The inspector continues to be aware that the majority of necessary material is already available within the home - it is now just a case of accumulating the correct information in the right documents. The purpose of these documents is to be able to present to prospective and new service users - and professionals / friends / relatives - a full and comprehensive picture of life at the home. The home has its own contract in place for each service user. This is also still to be revised, to reflect those small aspects of importance that add to a service user’s security and understanding of their ‘licence’ to stay at the home. Issues concerning the actual room and type of room – and statements concerning the liability issues if there is a breach of contract (i.e. when a service user may indeed be ‘asked to leave’) are lacking. Three service users have been admitted to the home in the past twelve months; two on a permanent basis and one for a ‘respite care’ period. Two service users had been discharged from the home and four had passed away some at the home and some subsequently in hospital, following admission. There were currently six vacancies at the home – four single rooms and two places in the shared bedrooms. The current fee at the home is from £365. The service user files showed that not only were comprehensive details provided by the Care Management of the individual placing authority of service users, but also the home additionally conducts an initial admission assessment for themselves, which covers all the major areas of information / identified needs as suggested under NMS 3.3 The skills-base at the home (through evidence of individual staff member’s knowledge and abilities) remains somewhat unclear; a request for a list of mental-health specific training and skills has not been forthcoming to the Commission. It is essential that the management is able to evidence the mental health skills-base of staff at the home – especially to prospective and current service users / relatives / placing officers who require evidence of the home’s staff members’ capacity to deal with situations which may arise with this client category – which accounts for half of the service users at the home. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 10 Involvement of mental health specialists to support the service users with mental health problems and to assist the home’s dealing with issues arising from such behaviours - such as Community Psychiatric Nurses and Psychiatrists - was available and appropriate. It is hoped – and required - that staff training will grow progressively to ‘connect’ better with this professional input. Linda Lodge does not provide intermediate care and therefore this standard is neither applicable nor inspected. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, & 11. Service users can rely on the home having a plan of identified care needs set out in the home to assist in promoting their wellbeing. Service users can expect their health care needs to be fully met through community resources and the vigilance of the home, though some service users with mental health issues could expect a more concentrated focus on their support, through better recording and previously better-informed observation. Service users may rely on the home to properly manage their medication, through appropriate systems and well managed / supervised policies and procedures. Service users can expect to be treated with dignity and respect at the home; regard for privacy extends to sensitivity around being expected to share a bedroom. Service users can be assured that at the point of serious illness, or death, they would be treated with dignity and their wishes – if shared and recorded, would be heeded. Surviving service users are quietly and sensitively supported to ‘come to terms’ with the loss of a friend or loved one. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 12 EVIDENCE: Each service user has a plan of care and it is good to see that daily reporting is being undertaken. The inspector would request that the generic use of phrases such as ‘No Problems’ (? suggesting a service user is a problem?) and ‘No change’ are replaced by a clear statement as to what a service user actually has done / achieved. Care plans also should seek to identify areas of activity /social engagement for each individual to be able to develop this aspect of everyday life which contributes so substantially towards a person’s wellbeing. “They’re very kind here – I feel very safe, yes, very safe.” – thus responded one service user to questions put by the inspector – suggesting a positive level of contentment. The majority of service users at the home are able to help themselves quite substantially in regard to personal care, etc. Only a couple of service users have continence problems and a similar number were identified requiring help with dressing and personal care tasks. Due to the 55 age admission level for those in the ‘mental health’ category, the general ethos and ‘feel’ of the entire establishment is one of ‘younger elders’. Reflecting the individual focus of care provided, a relative wrote: “I’m very grateful for the attention shown [by the home] towards my [service user’s] personal likes and dislikes.” About six GPs are involved in providing a service to the home; one local GP has commented that the “service users are well cared for and the staff are pleasant and helpful.” The inspector was able again to observe the storage and administration of medication in practice; staff members were dispensing medication appropriately and carefully; the process employed was concise and appropriate. Storage and the recording of medication for service users appeared to be well kept and ordered. With regard to those (currently ten) service users who have specific mental health needs, there is still identified a clear need to record more accurately the individual’s wellbeing in relation to their mental health status. They would not have been referred to the home without a specific need being identified, and so therefore the monitoring – by daily refection - on their fitness in this regard is essential – it can also help pre-empt the onset of problems. The hairdresser visits the home once a fortnight and provides a service that is reasonably priced (i.e. £6 – shampoo & set). Chiropodists from the NHS visit about three times a year; a private chiropodist is also, therefore, employed at a current charge of £16.00 a visit. Domiciliary dentists and opticians visit on a regular basis, providing services as required – and service users can be taken out into Sutton or Cheam for other community-based appointments. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 13 Service users can expect to be treated with dignity and respect at the home; all service users at the time of the visit were singly-occupying bedrooms; the two doubles were occupied by a recently-bereaved partner and another single person, whose sharing partner had left the home. The proprietors made it clear that they were ‘in no hurry’ to fill these two bedrooms with a second occupant. The home now seeks – appropriately, on the service user’s admission form information as to what service user’s preferences are with regard to actions to take if they are taken seriously ill, or pass away at the home. Some service users are not forthcoming on this issue, by all accounts – but at least the service users now know that they can record such requirements at the home. Accounts of deaths at the home (which are infrequent – usually an admission to the hospital is arranged for the final stages by the GP) demonstrated an appropriate and sensitive handling of such an event. A first-hand account by a service user whose partner had recently died told of the close and supportive nature of staff and management – this attention was still in evidence, in their concern for this individual. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15. Service users can expect to enjoy a mixed programme of activity and leisure pursuits at the home; they are also encouraged to engage with the local community resources available to meet their own religions and cultural needs, where individually wished. Visitors can rely on a positive welcome to the home and are encouraged to remain involved with the care and attention given to their loved one. Service users receive a satisfying, wholesome and nutritious diet - with the necessary need for adequate fluids being recognised alongside. EVIDENCE: ‘I’ve lived at the home for four years now – and its run very well. I have a lot of independence; they respect what you want to do.’ Thus stated a service user, indicating their feeling of being an individual rather than just ‘one of the herd’. Newspapers are available at the home through a local delivery – and one service user regularly stretches their legs to get a paper every morning. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 15 The mobile library regularly visits the home, and videos, DVDs and the use of satellite TV have expanded the horizons of some service users, who thoroughly enjoy sports and other programmes of interest. Board games such draughts, cards, ‘Frustration’ and dominoes, alongside Bingo and quizzes are popular - though within a very informal atmosphere of ‘passing the time’. A number enjoy the ‘stretch and exercise’ activity slot. Concerts are also occasionally held at the home – and invitations to local school events are sometimes received. Service users are encouraged to get out of the building – and indeed, a number of service users were observed to be enjoying exercise / walks either just outside the house, or ‘round the block’ or travelling – some by bus – to the local shops or into Sutton. Local afternoon trips out to Epsom, the ‘Duck Ponds’ or onto the Downs are enjoyed – as well as the more occasional trips to the coast. Holidays are enjoyed by a few service users, who are fortunate enough to have relatives organise such events. Two service users continue to attend previously used day care arrangements – this being seen as instrumental to their wellbeing and part of their care planned package. “I have always been made to feel very, very welcome whenever I visit.” Stated a relative in their questionnaire; other visitors were also seen to come and go –in a relaxed and cheery way. Staff related well to family members / visitors. Food is provided in service user’s rooms or in the dining room; and, especially for the main meals, service users are encouraged to ‘come out’ and share food in a social atmosphere. Service users commented: ‘It’s always good, the food’ – ‘It’s always served nice and hot.’ – ‘Gosh, yes, I get plenty to eat’. The home’s Menu was available on the dining tables – and covered two weeks, and included a second option, which service users may opt for. Service users stated that the food was generally in good quantity. During the hot summer months, the availability of fresh cold drink was seen as a priority and this was noted to be changed / refreshed a number of times during the day. One service user regularly enjoys a can of beer at around 10.30am in the morning – representing a nice personal service touch. Service users also confirmed that fresh fruit appeared in the fruit bowls regularly; and individuals were at liberty to take as much - or as little - for their own consumption. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18. Service users and their supporters can be confident that complaints will be taken notice of and action taken at the first opportunity by the proprietors. Service users can be assured that they are safeguarded from abuse by the policies, the staff knowledge and the conduct of the home in general. EVIDENCE: A good Adult Protection policy and procedure has now been evolved and implemented with in the house. The policy is clear and precise, and contains all the useful aspects such as the emergency contact numbers of the local authority duty teams for referrals to be made – and is held alongside the London borough of Sutton multi-agency procedure. All staff have now been trained in Adult Protection / Vulnerable Adults issues; this was provided at the home this last February. One issue of theft of money from the home was referred to the Adult Protection team; this has been resolved not satisfactorily to the home – but as far as is practicable. Only one complaint has been handled by the home in the past twelve months – concerning the size of meals provided; this was rectified by more food being provided to the said complainant – who is now satisfied. This issue was addressed immediately. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 17 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, 21, 22, 23, 24, 25 & 26. The establishment is a safe, well-maintained, clean and homely environment. Communal areas are pleasant, though the entrance hall – used as a smoking area – exposes all service users to smoke whether it is their preference or not. The home’s facilities lack a passenger lift, covers on some radiator surfaces, and a sluice-cycle washing machine (to promote infection control practice). The facilities provided will be more appropriate to the client groups accommodated, following an occupational therapy assessment - and the implementation of any recommendations arising from this study. Service users can expect to occupy a pleasant bedroom, individually furnished, and to access appropriate bathing and toilet facilities - and communal space. EVIDENCE: New dining room furniture has been provided at the home – and some bedrooms and the back corridor have been redecorated. The floor level in the back corridor on the ground floor has been raised to make a seamless pathway from most rooms to the bathrooms (only a few lie beyond, down one step). Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 18 Smoking is allowed in the entrance area – with the front door often open to help ventilate this area. The lounge closest to the garden (furthest away from the dining area) also accommodates this purpose. One comment in a questionnaire received stated: “I am a little concerned at the degree of smoking allowed in the home – particularly the entrance area – though this does seem to have improved of late.” The inspector would ask the proprietors to reconsider the home’s smoking policy - and to perhaps just designate the front lounge and associated garden area as smoking zones – thus ensuring that service users walking through to the staircase / public telephone / bedrooms do not have to passively inhale smoke. Whilst realising that this will perhaps hit the staff team most severely (a number of whom do smoke and take breaks in this area), the resulting benefit for the many non-smokers would be significant. The proprietors have identified an Occupational Therapist to come and visit and assess the home, from the perspective of the registration categories – i.e. ‘older people’ and ‘older people with mental health issues (past or present)’. This has been (and remains until completed) a requirement for some time. The absence of a lift or some form of transportation to the first floor of the home remains an outstanding issue – especially in a home for older people. The proprietors are required to investigate and consult on the installation of an appropriate solution. Obviously the Fire Service (LFEPA) will also require consultation with regard to such a significant installation. The home has taken steps to cover what is estimated to be about 60 – 70 of the hot surfaces around the home relating to the heating system. It is now mainly the communal areas that need to be completed in this regard; these have been left to last on the basis of lower risk relating to risk assessments. A previously identified requirement – concerning the installation of a sluicecycle washing machine, thus allowing the promotion of best practice in infection control – continues to remain an outstanding issue. Although the incidence of incontinence continues to be relatively low, the fact remains that being registered for older people, the home should have such a facility available to address such (inevitable) incidents. Facilities to provide adequate lighting, heating and ventilation are all suitably well maintained – all documentation relating to servicing and maintenance checks were in order Paper towels have now been provided in toilet areas, so addressing the minimising of risk of cross-infection. The commode sterilising room has now had its door reinstated – thus promoting infection control measures. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 19 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, 28 29 & 30. Service users can be assured that staffing is provided at the home in line with agreed, currently adequate levels. Staff training – especially to NVQ level 2 or equivalent in care – will soon held by sufficient staff members to guarantee safe practices within the home. Staff members are recruited within the context of safe employment practices, including appropriate Adult Protection and Criminal Record Bureau checks, with this now being supported by the involvement of an Employments Law & Rights Consultancy practice. Staff training is provided to many staff requiring such input, however the benefit of a formally constructed staff Training and Development Plan is yet to be developed. EVIDENCE: A minimum of four care staff are available to service users during the day, two coming on early and two arriving a little later - and carrying the shift through to the evening, when two night staff are available throughout the night. Service users and relatives appeared happy with the staffing levels provided at the home. Bank / Agency staff are not used; the present staff team are able to ‘cover’ shifts when the home is short. Senior staff members are also available throughout the week; both the manager and her sister - the deputy manager, are on site most days. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 20 Only two staff members have left the home since the last inspection; both moved away from the area (one to Ireland). Eight staff members – the more senior on shifts – were in charge of medication, and took charge in the absence of one of the managing proprietors. A member of staff specifically spoken to stated they enjoyed working at the home – though, commendably, would like to attend more training courses. Staff training in the past year has covered Health & Safety, Moving & Handling, Medication, Adult Protection, various items of in-house training and three staff members are undertaking NVQ in care at Level 2, and one at level 3. A total of eight staff (out of twenty) had - or were taking - NVQ 2 in Care, or held an equivalent, or superior, qualification. The home is not far from achieving the minimum level of qualified staff as expected by the end of this year (2005). Fifteen of the twenty staff members held current First Aid certificates. A ‘refresher’ on use of the hoist / moving and handling had taken place the day before the inspection visit. Future training courses planned include: ‘Infection Control’ and the NHS chiropodist providing training on nail cutting / basic foot care. Staff are suitably referenced and all – including long-term employees - are ‘CRB’-checked now; the proprietors had to ensure that staff who were employed currently elsewhere as well were not using their CRBs in a ‘portable’ mode – this process not being allowed any longer within care homes. Only two staff members (one who was on maternity leave and one who was long-term sick) were not now fully CRB checked – these checks were planned before either returned to work at the home. The home lacks a Staff Training and Development Plan – this area is the responsibility of the currently absent senior carer. Such areas should be also within the remit of the manager / proprietors and, as such, when a senior is unable to provide the continuity in this regard, the proprietors should ensure that this is seamlessly taken over either by themselves of by another responsible senior person. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 21 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, 33, 34, 35, 36, 37 & 38. The proprietors, though experienced in running care homes, have yet to commence a professional training course to suitably qualify in management and care to the level required for competent managers – NVQ Level 4. The home runs informally on a ‘listening’ basis, but would benefit by insights afforded by quality assurance audits both by service users and other stakeholders. Such ‘research’ would inform the formulation of a Development Plan and a Business and Financial Plan – both of which are lacking, currently. Service users can be assured that the general financial management of the home is sound and that the management of their monies held in safekeeping is secure and appropriately recorded. Staff members are not well supported in that they do not currently receive the one-to-one supervision nor ongoing staff meeting peer support they should, due to the absence of certain senior staff. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 22 The absence of some policies and procedures leads to deficits in the service; Access to staff files is a significant lack, whilst some others are in need of implementation to complete the homes procedures manual. The health and safety of service users is generally protected by the proprietors, who maintain the home in a safe and well-serviced state. EVIDENCE: The proprietors manage the home; Mrs Lynda Penfold is the registered manager and Miss Tina Freed and Mr Barry Freed are the assistant managers. Ms Zeta Murdoch is the ‘Night Staff Supervisor’ – and plays a principal role in staff training and supervision; more recently Ms Murdoch has been off sick. One area that requires strong development is that of quality assurance and the associated forward planning, incorporating the outcomes of consultations and audits undertaken with service users, relatives and stakeholders. A resultant Business/development Plan should be able to ‘map out’ where a home is heading and how the goals will be achieved. The home fails itself in this regard as – as indicated by the slow development around access to the first floor by some form of passenger lift – newcomers to the home are not clear what the future holds for the home, without such clear intentions being devised and committed to. A policy now exists for service users in relation to Data Protection; the proprietors are now in the process of applying a similar process with regard to staff members (surprisingly, the Human Resources company employed by the home does not provide such a document). Three service users continue to handle their own financial affairs, drawing money and paying their contributions. The majority (eleven) of service users have relatives handling their finances for them. The home only holds small sums of money in safe keeping for some service users; they are not ‘appointee’ for anybody. Records of financial transactions are suitably kept. Formal staff supervision is still to be fully implemented at the home; this had been delayed due to the illness of one of the senior staff member who has a responsibility for staff training and support. The proprietors admitted that this absence had ‘caught them unawares’ – and realise that such issues cannot necessarily wait for the return to work of a single member of staff. A secondary issue is that the home is staffed by a number of workers who undertake just one or two shifts a week; this makes it more difficult to develop a career pathway / professional direction for such ‘part-timers’. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 23 Staff meetings – for this self-same (1/2 shift a week) reason cited above – are also difficult to arrange, with little hope of having the majority of members on site for a corporate gathering. Only two / three meetings were held in 2004. This situation, clearly, must be improved – especially for those daytime staff members who work regular and significantly fulltime hours. The lack of ‘connective-ness’ between staff surely demands a tighter system of staff communication. The proprietors must resolve such a situation urgently. Policies and procedures regarding ‘First Aid’, ‘Sexuality and Relationships’ & the ‘Homes are For Living In’ values-base were still due to be put in place, to complete the home’s Procedures Manual content. Health & safety issues relating to maintenance and servicing of equipment was up-to-date at the time of the inspection; records were seen and verified the content of the pre-inspection questionnaire submitted by the proprietors. Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 1 3 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x 1 1 3 1 2 3 Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 25 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 1 Regulation 4&5 Requirement The Statement of Purpose and Service User Guide must be rationalised to clearly represent the two documents required by regulations 4 and 5 and fully described in those regulations, the associated Schedule 1 and the Standard 1.1 and 1.2 (Timescale of 30.10.04 not met) The manager must evidence the mental health skills base of staff at the home to the Commission. (Timescale of 30.10.04 not met) Timescale for action 15.10.05 2. 4 18 15.10.05 3. 8 17 - Sch 3 A formal recording structure is required for mental health service user’s psychological health to be noted at the home. (Timescale of 30.09.04 not met) 23(2)(n) A proposal must be evolved, agreed by the proprietors, and communicated to the Commission as to how the home proposes to ensure that a lift of some form is provided to transport service users to the first floor level of the home. Such plans must also be submitted to the Fire Safety 15.10.05 4. 22 15.10.05 Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 26 Section of the London Fire & Emergency Planning Authority for their comment. (Timescale of 30.09.04 not met) 5. 25 13(4) All remaining exposed radiators and hot water pipes in the home must be protected or replaced with low temperature surface units. (Timescale of 30.11.04 not met) A sluice-cycle washing machine must be provided in the home. (Timescale of 30.12.04 not met) 15.10.05 6. 26 13(3) 15.10.05 7. 30 18 A Training and Development Plan 15.10.05 must be devised for the home to indicate the establishment’s commitment to ensuring adequate staff training particularly in mental health issues. (Timescale of 30.11.04 not met) 15.10.05 An annual Audit of the service provided must be undertaken, involving service users and families & friends and other stakeholders, resulting in a Development Plan. A Business and Financial Plan must be put in place, be open to inspection, reviewed annually. (Timescale of 30.11.05 not met) Formal staff supervision for all staff must be commenced, being of bi-monthly frequency - and providing the minimum content required by this Standard. (Timescale of 30.10.04 not met) A policy relating to Access to files is required for staff members. 15.10.05 8. 33/34 24 & 25 9. 36 18(2) 10. 37 17 15.10.05 Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 2 Good Practice Recommendations To fully meet the ‘Contract’ standard, space should be given to indicate the room’s type and number, and to state more fully ‘the rights and obligations of the service user and the registered provider and who is liable if there is a breach of contract’ (2.2). That care plans should reflect more fully the individuals social needs and satisfactions - and that the day-to-day notes actively reflect on these engagements. That the entrance area to the home should be designated a No smoking area, on the basis that many non-smoking service users have to experience / passively inhale smoke whilst waiting in / moving through / accessing stairs to their rooms. That an occupational therapist’s assessment of the home with a view to providing all equipment, as useful, to the older aged service users should be sought and these recommendations implemented. That NVQ training should be undertaken by care staff to ensure 50 staff members are trained to Level 2 in Care by the end of 2005. That the manager(s) should seek to qualify to NVQ level 4 in Care and Management, or equivalent, by the end of 2005. That policies and procedures regarding ‘First Aid’, ‘Sexuality and Relationships’ & the ‘Homes are For Living In’ values-base were should be put in place. 2. 7 3. 20 4. 22 5. 28 6. 31 7. 37 Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP 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 Linda Lodge G53 G53S7164 lindalodge V195041 120505 stage 4.doc Version 1.30 Page 29 - 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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