CARE HOMES FOR OLDER PEOPLE
Linda Lodge 91 Worcester Road Sutton Surrey SM2 6QZ Lead Inspector
David Pennells Key Unannounced Inspection 24th January 2008 12:30 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 Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Linda Lodge Address 91 Worcester Road Sutton Surrey SM2 6QZ 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) 020 8642 0343 N/A Ms Tina Freed Mrs Lynda Penfold Mrs Lynda Penfold Care Home 26 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Old age, not falling within any of places other category (0) Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for 13 Elderly and 13 ‘older’ people with mental ill health. 7th June 2007 Date of last inspection Brief Description of the Service: Linda Lodge is a large, extended family house situated on the west side of Sutton, being also 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. Parking is available on site and is free in the road alongside. The surrounding environment is a pleasantly green and well-treed suburban Surrey residential area. Half the total population of the maximum of twenty-six people living at the home are of the general ‘elderly’ (65 ) registration category, and half are generally over the age of 55 and have some form of past or present mental health difficulty. The general ‘mood’ of the home is for older / mature people. The home offers single bedroom accommodation to twenty-two of the total maximum of twenty-six service users, though the two potentially doubleoccupancy rooms currently continue to accommodate two ‘single’ occupants. The entrance hallway 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, public telephone booth, staff room and kitchen is also through this area. The main communal space is pleasant, and provides two separate lounge areas, one adjoining the dining room. Smoking is now only permitted outside in the garden. The patio area has good, solid garden furniture and is a pleasant area when the weather is good. The home still has one remaining issue to address to meet the general needs of the basic requirements within the old age category of the home. The provision of a passenger lift / transport to the first floor remains an outstanding requirement; fortunately, those people who use the upstairs bedrooms are reasonably agile / mobile. The proprietors are currently investigating options in this regard for the future, and keeping the Commission abreast of these developments. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. We spent much of the time during the visit to the house talking to the two principal proprietors about the service, and assessing progress made in addressing the twelve requirements brought forward from previous inspection visits. This is the second key inspection within the year for Linda Lodge; this higher frequency of inspection reflecting a concern about the ‘poor’ rating awarded to the home after the last inspection visit (relating in particular to a lack of staff support and training, and a number of other management -related facets). We also spoke to a significant number of the people who use the service about how they found the home - and to one district nurse who was visiting the home that afternoon. We again examined paper work relating to the building, and also checked both staff files and some files and records (including medication records) relating to the people who live at Linda Lodge. We are grateful to the service users, staff and the co-proprietor of the home for their welcome, cooperation and hospitality. What the service does well:
The service provides a warm and generally comfortable environment for people living there, to go about their business in an independent and generally dignified manner. The ‘younger’ people in the age range - of the mental health client group - approximately 50 , helps ‘anchor’ the population living at the home in the ‘younger’ age bracket / approach, encouraging self-help, activity and communication; it is clear that this attitude at the home does encourage continued activity - and participation in the outside community - by a number of those living there. Although some people using the service are of significant older age, they are all able individually to contribute an opinion about life at the home. This is evident through a wide choice of food, through people continuing to manage their own finances, and through the individuality expressed in their personalised bedroom styles. Rooms provided are individual and well decorated - a number have been redecorated / recarpeted recently. Communal space in the home is pleasant - and more generally available to all who live at the home, due to the home adopting a ‘no-smoking’ policy throughout. As questionnaires in the most recent (June 2007) inspection brought little response, no relatives or users of the service were canvassed for written views in writing prior to this inspection; we relied again on the directly expressed views offered by the people living at the home at the time of the inspection.
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
Requirements set at this inspection again bring forward themes from previous inspection visits. They range from the need to plan for, evidence and ensure staff general induction, training and support in both the ‘mental health’ and general ‘old age’ category of the home is provided, through to professionally supporting staff through one-to-one staff supervision and annual appraisals, to ensuring fire drills are carried out regularly. As the elements concerning staff induction training and supervision have been outstanding for some significant period of time, the Commission has decided
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 7 that enforcement action is necessary to ensure that the service actually does improve in these areas; a statutory Notice has therefore been issued - with a requirement that appropriate action be put in place by 20th May 2008. The proprietors are currently undertaking some research to enable them to indicate to the Commission how they will address the issue of there not being a passenger lift to the first floor of the home - an important element in any care home for people in an ‘older people’ category. Plans are currently, it is understood with the London Fire & Emergency Planning Authority. Health & safety lapses - the planned fire drills again not being undertaken regularly - and ensuring the annual professional testing of the integrated fire alarm system - continue to suggest a lack of management control in both planning and oversight, and are areas to be kept ‘up to speed’ for the future. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 8 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 Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users can be sure that - both prior to, and on admission - information is gathered to ensure a suitable service can be provided at the home. The staff competency / training profile does not at present necessarily assure a service user who has a mental health diagnosis that the home is sufficiently ‘skilled up’ to fully support them, through having a staff team with adequate mental health training / background. Linda Lodge does not provide intermediate care and therefore standard 6 has not been inspected or assessed. EVIDENCE: The Linda Lodge information brochure contains a sample copy of the Terms & conditions for the home.
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 10 Charges additional to the fee are made for: Hairdressing, newspapers, private chiropody, non-NHS dental work, toiletries, holidays, transport and clothing. A newcomer to the home had a full comprehensive assessment and initial care plan in place on file; the person in question stated they were settling in very well, and preferred the placement to their previous care setting. We were pleased to note resource / information files - available in the staff room, which carried a lot of useful, contemporary information about different mental health conditions. Staff members sign to say they have read the folder. The home has also access to a brochure detailing training resources available from the mental health charity ‘Mind’ - some of which it is intended to buy. We continue to express our concern through a reiterated requirement regarding the active training of staff so that the service competently meets the needs of the ‘specialist’ mental health focus - that accounts for half of the people using the service at the home. As this has now been an ongoing requirement of the home for some years now, the Commission has decided to impose a Statutory Notice - issued on 21st April 2008 - which requires the coproprietors to comply with a requirement in regard to staff training by 20th May 2008. The proprietor’s previous action plan dated 28/02/07 submitted to the Commission, stated: “Mental health training 1 staff: ‘Working with women with mental health’ - 2004 10 staff: ‘Adult Protection’ - 2005 (a generic care course) 9 staff: A mental health talk on ‘Anxiety’ - 2005 (by a CPN) 2 staff: ‘Managing suicide and self harm’ - 2004 (both proprietors) 1 staff: ‘Community mental health care, level 3’ - 2004 (night staff) 1 staff: ‘Abuse awareness’ - 2004.” The proprietors confirmed to us that no staff at the home had undertaken any further training in this important area since. As stated in the last report: “It is essential that the management seek out / provide - and provide documentary evidence for - further mental health training for staff at the home. This is an essential knowledge focus - especially to prospective and current service users / relatives / placing officers. Both the Commission and prospective purchasers of the service will require evidence of staff members’ capability to deal with situations that well may arise with this client category.” The proprietors were actively encouraged to push for appropriate training in the ‘host’ borough, to seek training that may be available from other local authorities, to seek out training via the Web, and to find local organisations that may well be able to assist the home in training opportunities. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 general vigilance of the home’s staff. Service users may rely on the home to properly manage their medication, through appropriate systems / procedures, and to have well managed / supervised policies and procedures, with staff adhering to them. Service users can expect to be treated with dignity and respect at the home; regard for privacy extending to personal sensitivity around the expectation to share a [double] bedroom, where necessary. EVIDENCE: Questionnaires were sent before the last inspection visit to the four GP practices which serve the home; the majority responded, with a positive
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 12 reaction to the service they experienced / observed in the home. A district nurse visiting the home felt positive about the service being provided, being happy with the support they gain from the staff at the home. We spent some time checking the case file for a newcomer at the home, which showed that daily records are kept alongside care plans. Annual ‘reviews’ for each person are conducted minimally for each service user - this generally involving other professionals appropriate. Some people at the home, it was noted had ‘lost contact’ with their placing officer, this sometimes making it difficult to sustain a contact with the placing authority. The personal files clearly continue to be more focused and purposeful than before. This noted improvement seeks to focus in on the mental-health status of those who are in the home by virtue of their specific support need. Accident records were seen and risk assessments were also present where needed. The majority of people at the home again continue to help themselves quite substantially in regard to personal care, etc. The majority of those using the service are seen as having low care needs. Only a very few have any continence problems, with a few requiring help with dressing and personal care tasks. Any person suffering pressure area problems were appropriately cared for with District Nurses attending them regularly, and the appropriate pressure relieving equipment being in place to support them. Due to the 55 age bracket / admission level for those in the ‘mental health’ category, the general ethos / ‘feel’ of the establishment is one of ‘younger elders’ - and this self-help ethos pervades the home to a significant extent. We again observed the storage and administration of medication; staff members give out medication appropriately and carefully; the process employed being appropriate. The majority of staff - including the proprietors are trained in administering medication; four staff more recently having attended a ‘Safe handling of medicines’ course at Nescot. Storage and the recording of medication was appropriately kept, and stocks were well ordered. A new small medicines refrigerator has been purchased. The hairdresser visits the home once a fortnight. Chiropodists from the NHS also visit a number of times a year; a private chiropodist also visits making a very reasonable charge per visit, and ‘plugs the gaps’ of the statutory provision. Domiciliary dentists and opticians visit the home on a regular basis (the latter quite recently), providing services as required – and people can also visit / be taken out into Sutton or Cheam for other external appointments. People are generally treated with dignity and respect at the home; all living in singly occupied bedrooms; the two double bedrooms occupied by a single person each. The proprietor has previously made it clear that they would not ‘fill’ these two bedrooms unless it was the occupant’s active wish.
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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 religious and cultural needs, where individually expressed / identified. Visitors - especially relatives and friends - can expect a positive welcome to the home, and are encouraged to remain involved with the care and attention given to their loved one, ensuring a ‘shared’ care approach. Service users can expect to be supported and encouraged to exercise their own choice, ensuring the retention of some personal control over their lives. Service users receive a satisfying, wholesome and nutritious diet - provided in suitable variety, with the necessary need for adequate fluids being recognised alongside this good service. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 14 EVIDENCE: The two proprietors have recently completed a certificated training course on ‘Provision of activities in the care setting’ - run by Nescot. A number of service users enjoy the ‘stretch and exercise’ activity slot. Games such as draughts, cards, ‘Frustration’ and dominoes, alongside Bingo and informal quizzes are popular, within the very relaxed atmosphere of ‘passing the time’. Concerts are also occasionally held at the home – and invitations to local school events are sometimes received and subsequently attended. The mobile library regularly visits the home, and videos, DVDs and the use of satellite TV has expanded the horizons of some service users, who thoroughly enjoy sports and programmes of interest communally or in their own rooms. Newspapers are available at the home through a local delivery service. Those living at the home regularly stretch their legs to get out to the local shops or to walk ‘around the block’. Local afternoon trips out to Epsom, the ‘Duck Ponds’ or onto the local Surrey Downs are enjoyed – as well as the more occasional summer trips to the coast. Relatives and visitors are positively welcomed to the home at any time of the day and all previous reports have spoken of the positive welcome received. Religious activity is ‘low key’ within the home - those using the service can go out to religious activities / Services, or may invite people of religion to their own space; one person does welcome religious visitors to visit them privately. Food is provided in people’s own rooms or in the dining room; though especially for the main meals - people are encouraged to ‘come out’ of their rooms and share food in a more social and engaging atmosphere. The home’s menu is available on the dining tables and in the lounges – and covers two weeks, including a second option, which people may opt for. Dietary preferences can be provided for. People spoken to have stated that the food is generally in good quantity, and always served ‘hot from the kitchen’. A number of people coming away from the lunchtime tables stated how satisfied they were with their food. One staff member has undertaken training in ‘Nutrients & health’ in the last year, and five staff have quite recently undertaken Food Hygiene training. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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, staff knowledge and the conduct of the home in general. EVIDENCE: The home has a complaints policy and procedure. The home seeks to resolve issues at the local level before they become a serious problem / issue. Records evidenced that issues have been addressed immediately at the point they arise in the past. A good Adult Protection policy and procedure exists within 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 agreed multiagency procedure. Almost all staff members at the home have been trained in Adult Protection / Vulnerable Adults issues. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The establishment is a generally well-maintained, clean and homely environment, enhanced by the change of the service to a ‘no smoking’ ethos. The home lacks a passenger lift or similar facility, this issue must be addressed to ensure the home fully meets the ‘older people’ national minimum standard requirements and resulting in a fully accessible and safe environment for the people living there, both now - and into the future. The home is clean and hygienic, providing all such equipment to ensure that best infection control measures are in practice. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 17 EVIDENCE: We have again found that the premises present as a homely and comfortable environment for people to enjoy - as if it were their ‘own home’. All bedrooms are individually furnished, warm and welcoming. Some bedrooms have recently been redecorated and recarpeted. The front hallway, stairs and landing have been recarpeted and refurbished. In regard to the issue of there being no assisted mechanism to get to the first floor bedrooms, the proprietor’s previous action plan dated 28/02/07 provided in response to the last inspection report requirement - stated: “All our clients on the first floor are able bodied and can manage stairs, these clients are regularly reviewed. Therefore it has been that a lift at the present time would not be financially viable within the current financial year, but will be reviewed in the next year.” This reality continues, however, and the proprietors are actively exploring the issue and getting a survey / quotes from a company to gain a full perspective on the possibility of improving access to the upper floor. It is understood that the plans are currently with the London Fire and Emergency Planning Authority. The requirement from the previous report - relating to covering the remaining radiator surfaces that were not low surface temperature units, has now been addressed. Most contracts and documentation concerning regular maintenance / safety checks were available - but evidence of the portable electrical appliance testing - other than the invoice from the electrician’s company - was not held on site. Issues arising concerning health and safety with regard to the fire alarm system are covered in the ‘management’ section of this report. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be assured that staffing is provided at the home in line with previously agreed formula for staffing levels, though the skills / qualification mix is not in line with the home’s focused registration categories. Staff training to NVQ Level 2 in Care or equivalent, is now at a level which ensures that sufficient staff members are qualified to guarantee safe and appropriate care practices within the home. Staff members are recruited within the context of safe employment practices, including appropriate Adult Protection and Criminal Record Bureau checks, ensuring the safety and wellbeing of people using the service. Staff training and induction needs to be more consistent and substantial to ensure adequate and appropriate service to those using the service. The benefits of a formally constructed Staff Training & Development Plan must be used to identify deficits that need to be addressed. 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. Staff members were being sought at the time of the inspection.
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 19 Few staff members have left the home since the last inspection visit indicating a stabilisation in the staff team - which will work for the benefit of those living at the home. For a discussion of the issues raised with regard to mental health-appropriate focus / training, the reader is referred to the first section of this report standard 4. Ten staff undertook First Aid training in November 2006. Five staff members have also more recently completed Food Hygiene training, and eight (including the proprietors) took part in a Fire Safety course. We checked the file for one more recently started staff member - which showed that they had formally applied for a post using the home’s application form, that references had been taken up, that Criminal Records Bureau (CRB) checks had been undertaken prior to employment, and letters were on file to confirm the contractual agreement. We checked induction records for this ‘new’ staff member and found there was no record of induction on file. In discussion with the proprietors it was clear that contact had not been made with Skills for Care - recommended in the last inspection report from June 2007 - and consequently induction was still poorly undertaken - if at all, at the home. It is hoped that the skills for care model of induction will be ‘blended’ with the need for the giving of ‘local’ information about the home - to produce an adequate document for the future. This ongoing concern is now being considered in the context of enforcement action; a Statutory Notice has been issued on 21st April 2008 to require the coproprietors to comply with a requirement in regard to staff induction by 20th May 2008. The Commission’s minimum standard of at least 50 staff trained to, minimally, NVQ Level 2 in Care has now been achieved. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The registered manager / owner is experienced in running care homes, and having commenced a professional training course for registered managers this should lead to enhanced management processes at the home. The home would benefit by insights afforded by the home’s quality assurance audits of service users and other stakeholders being more actively used. People using the service can be assured that the general financial management of the home is sound, and that the management of monies held in safekeeping is secure and appropriately recorded. Staff members continue not to be well supported, in that they do not receive the one-to-one supervision or appraisal support they should have, this resulting in a less focused service for those living at the home.
Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 21 The proprietors have routines in place to generally protect the health, safety and welfare of both people using the service and staff members, though maintaining the routines rigorously must be monitored - to ensure the home remains in a safe and well-serviced state. EVIDENCE: The manager/co-proprietor - Lynda Penfold was now working at the home again, following an absence, during which time her sister, the second registered provider Miss Tina Freed, covered the management at the home in a ‘deputy manager’ capacity. Mrs Freed’s brother, Barry Freed, also assists at the home on a regular weekly basis - and is seen as a second Assistant Manager. There are no ancillary staff members provided, so all care staff members need to have multiple skills, and the management of the service has to build these elements into the daily routine. The proprietor has enrolled and started on a RMA Course and her Assessor had visited the home, the course proper now starting. The Inspector saw the Course portfolio. Miss Freed has also started on a training course relating to staff supervision and support. Notwithstanding the above management training focuses, the proprietors admitted that the requirement to provide regular staff supervision, appraisals and induction had still not started, because they had not got the right forms in regard to the former issue, and had not accessed the Skills for Care resources (which are openly available) in relation to the latter. As this has been an ongoing concern for some time, the Commission is taking enforcement action in regard to these important issues; a Statutory Notice has been issued on 21st April 2008 to require the co-proprietors to comply with a requirement in regard to staff supervision (and appraisals by extension) by 20th May 2008. We continue to have concerns that the lack of ongoing professionally focused support for staff can lead to a lack of identifying individual training and learning needs, and hence leads to a poor input for the service. This area, also highlighted in the first Standards section of this report, is also being considered in regard to enforcement action, as again this area has been an outstanding issue for some time. ‘Quality Assurance’ at the home is covered by the introduction of questionnaires for service users and stakeholders. It is hoped that the outcome of such surveys would inform the future planning of the service. Initial ‘How was it for you?’ questionnaires are used by the service to check the quality of acre for newcomers to the home, but there is little subsequent ongoing monitoring. This should be further developed. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 22 Financial accounts were not examined at this visit, but inspections have previously found that a number of people who use the service continue to maintain their own benefit and account books, whilst a significant number manage their own financial affairs. Some people resident at the home are under a Power of Attorney order. General financial records operated by the home have consistently appeared to be in order when fully inspected. We found that records of some of the basic weekly health & safety checks showed that they had been restored (fire alarm testing) - following their inexplicable discontinuation prior to the last inspection visit. Fire drills continued to be an issue where vigilance is needed to ensure that all staff members experience the reality of such a surprise ‘rehearsal’ - false alarms (most of which appear to happen in the early waking morning) are not to be relied upon, as they are not involving those living at the home to any extent (most appear to remain in their rooms) - and are not created with the intention to be structured learning experiences for staff members. On checking the fire safety elements in the home, it became apparent that the last fire system checks carried out by a professional contractor could be evidenced back to 27/02/06. The proprietors were able to confirm to the inspector on the day following the inspection that the system was to be professionally tested within five days of the discovery of this deficit. The two issues in the two paragraphs immediately above appear to be ongoing examples of the loss of ‘management planning & overview’ - quite possibly due to certain pressures that have been on the managers recently. Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 23 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 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 1 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 1 Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 24 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 persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Providers must comply with the given timescales. No. 1. Standard OP22 Regulation 23(2)(n) Requirement A proposal must be evolved, and communicated to the Commission, as to how it is intended to ensure that a lift to the first floor level of the home is provided. Plans must also be submitted to the Fire Safety Section of the London Fire & Emergency Planning Authority. A Staff Training & Development Plan must be devised to demonstrate the registered provider’s providing adequate staff training - especially in mental health issues. Annual appraisals of staff must be commenced to enable a focused approach to staff development and retention. (Timescale of 31.12.07 not met.) Regular planned Fire Drills must be undertaken to ensure that staff and service users are all conversant with the procedure. (Timescale of 31.10.07 not met.) Timescale for action 20/05/08 2. OP30 18 20/05/08 3. OP36 18(2) 20/05/08 4. OP38 23 (4)(d)/(e) 20/05/08 Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 25 5. OP38 23 (4)(c)(iv) Fire alarm systems must be regularly professionally tested and maintained to ensure the safety of the entire population living or working at the home. 20/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Linda Lodge DS0000007164.V357697.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© 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 DS0000007164.V357697.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
