Inspection on 05/10/06 for Linda Lodge

This inspection was carried out on 5th October 2006.

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 17/01/06

Linda Lodge 12/05/05

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 Key Unannounced Inspection 5th October 2006 10:30a 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.V311657.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.V311657.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.V311657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 13 Elderly and 13 either elderly or aged 55 with mental ill health. 17th January 2006 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 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 outside. The surrounding environment is a pleasantly green and well-treed suburban Surrey residential area. Half the total service user population of twenty-six are of the general ‘elderly’ (65 ) registration category, and half are over the age of 55 and have some form of past or present mental health difficulty. Currently there were five vacancies on the ‘older people’ category - the mental health ‘quota’ of 13 occupants (maximum) being fully occupied. The home offers single bedroom accommodation to twenty-two of the total maximum of twenty-six service users. The two potentially double-occupancy rooms currently continue to accommodate two single occupants. 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, public telephone booth, staff room and kitchen is also through this area. The main 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 of fulfilling basic requirements within the old age category of the home: the provision of a passenger lift / transport to the first floor continues to remain an outstanding requirement, and limits the use of these bedrooms upstairs to reasonably mobile service users. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit spanned a period of about six hours, during which time the inspector was able to meet the co-proprietor, some care staff and a good number of service users resident at the home. The proprietor / manager, Lynda Penfold, was away on holiday at the time of the visit - but Tina Freed her sister and the co-proprietor, was well positioned to speak for the home, as she works full-time at the home now, as well. The purpose of the inspection was to audit the home against the key national minimum standards for older people, with the review of previous inspection requirements and recommendations and with checks of current documentation. The inspector also spent a good proportion of his time speaking to those who use the service - sharing lunch with them and meeting a number as he toured the home. Questionnaires concerning the service had also been sent out - and returned from a number of GPs, health and social care professionals. The inspector is grateful to the service users, staff and co-proprietor of the home for their welcome, input and hospitality. What the service does well: The service continues to provide a warm and comfortable, generally safe environment for service users to go about their business in an independent and dignified manner. 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; it is clear that the ‘youthful’ attitude at the home does encourage activity and participation by all. Although some service users are of significant old age, most (one in their centenary year) are able in some way to contribute an opinion, or observation, about life at the home. This was evident through choice of food, through service users continuing to manage their own finances, through the individuality expressed in service user’s rooms, and in the support provided. Rooms provided are individual and well kept, being personalised and well decorated. Communal space in the home is pleasant - especially now the home’s entrance hallway – used as a communal meeting point – is a ‘nonsmoking’ area. Staff and management provide an unobtrusive, ‘homely’ service of care and attention to the service user group, which is appreciated - this again being Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 6 evidenced by the number of compliments received from service users (both long-term residents and newcomers), talking about their own experience of the care and service provided at the home. Respondents to the Commissions questionnaire - GPs and other care professionals, and [only] one relative of a service user - all spoke / responded positively of the service. What has improved since the last inspection? What they could do better: Requirements set at this inspection bring forward the majority of the themes from the last inspection visit and range from the continued need to evidence and ensure staff training and support to the need to focus on the ‘mental health’ category at the home. The proprietors are again required to replace the worn first floor corridor carpet, and are also required to indicate how they will address the issue of there not being a passenger lift to the first floor – an ‘essential’ in any care home for older people. A number of radiator surfaces are also still awaiting their safety covers - though high-risk areas have been addressed. The overarching need arising from this report is again to focus on the ‘Management’ requirements contained herein, not least of all being the Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 7 requirement that the manager urgently qualifies in Management & Care to Level 4 - a course she has still not yet started. Staff qualification requirements at NVQ Level 2 have also not been met; at least half the care staff members should have been qualified a year ago to NVQ at [minimally] Level 2. Other management aspects not yet met cover the need to ensure that staff members are properly supported through training plans, through one-to-one supervision with trained staff, and through regular staff meetings being held. The proprietors also need to be aware / able to plan for the future of the home - through having a Development / Business & Financial Plan to guide a way forward for the service. Without such an overarching view, the home may well lose sense of its identity and direction – this would be a great shame, as Linda Lodge is clearly a valued resource for those who use it; this being evidenced by many comments received by the inspector throughout his visit and from many local professionals - both from the perspective of general health and mental health in particular. 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 DS0000007164.V311657.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.V311657.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 6. Prospective service users have access to a comprehensive set of information both before, and at the point of, admission through a comprehensive Statement of Purpose and Service User Guide being available. Service users are provided with a contract stating terms and conditions of occupancy, with specific detail making clear conditions relating to a service user’s residence at the home. 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 is not inspected or assessed. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 10 EVIDENCE: The first two judgements are reiterated here for the reader’s information - they were both found met - although they relate to standards 1 and 2 that were not directly inspected at this visit. Key Standard 3 was assessed at the most previous inspection visit in January and was found met; the third judgement statement above reflects this. A concern continues and is raised again in a repeated requirement - about the mental health skills-base of staff at the home (through evidence of individual staff member’s training / knowledge and abilities) - which remains an issue. The span of mental health-specific training and focus on this specific skills-base of care staff continues to be poor. The owners have previously accessed a couple of talks from the visiting CPN (Community Psychiatric Nurse) and are seeking training input from the local authority; however 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 - which accounts for half of the service users at the home. Standard 6 does not apply to this home - Linda Lodge does not provide an Intermediate Care service. Linda Lodge DS0000007164.V311657.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. 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. Service users may rely on the home to properly manage their medication, through appropriate systems and well managed / supervised policies and procedures being implemented, 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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 12 Each service user has a plan of care and daily reporting is being undertaken in respect of each service user. The inspector again reminded the co-proprietor to encourage staff to avoid ‘generalisms’ (terms which lose their meaning) in writing up reports, though this aspect does appear to be improving. The service user files have been rearranged and are more focused and purposeful than before. This is noted to be an excellent improvement, and included in this is the home’s commitment to focus in on the mental-health status of those who are in the home by virtue of this specific support need. Holistic annual ‘reviews’ for each service user are conducted minimally for each service user - this generally involving care managers / social workers / Community Psychiatric Nurses / doctors as appropriate. A number of reviews with such professional input are also conducted on a six-monthly basis; this dependent on the individual service user’s identified needs. The proprietor reported an improved input by external professionals in this regard. The majority of service users at the home continue to be able to help themselves quite substantially in regard to personal care, etc. Only a very few service users have continence problems - and a similar number were identified requiring help with dressing and personal care tasks. Due to the 55 age bracket / admission level for those in the ‘mental health’ category, the general ethos and ‘feel’ of the entire establishment is one of ‘younger elders’ - and this self-help ethos pervades the home to a significant extent. At least five GP practices are involved in providing services to those resident at the home, the Commission’s direct request for comments about the service provided at the home elicited a response from nine difference GPs - all of whom indicated they were content with the service provided at Linda Lodge. A variety of qualitative comments were also offered: “very good care” …… “general care good”…“there has been excellent interpersonal communication between my registered patients and staff members”….“contact to general practice services have always been appropriate and timely.” Regarding the service provided to those with mental health needs, two doctors within the area mental health teams commented: “I am very happy with the care provided at this home” and: “one of the better homes in the area we serve…. it appears well run with staff happy to help. I have no concerns.” Four Community Psychiatric Nurses or Care Managers responded positively to the standard questions, with just one respondent commenting that they had a concern with the monitoring of [a] service user weight and [b] compliance with self-medication - which could be improved. One relative of a service user kindly responded to the relative’s questionnaire which again was all positively completed, except for a comment that they were unaware of the home’s Complaints Procedure. They also added the comment: Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 13 “I have seen many improvements in [their relative’s] care - and feel very reassured that she is well looked after…” The inspector was able again to observe the storage and administration of medication in practice; staff members dispensed medication appropriately and carefully; the process employed was concise and appropriate. Storage and the recording of medication appeared to be suitably kept, and well ordered. The hairdresser visits the home once a fortnight and provides a service that is reasonably priced. Chiropodists from the NHS also visit about three times a year; a private chiropodist also visits making a very reasonable charge per visit. Domiciliary dentists and opticians visit on a regular basis, providing services as required – and service users can visit / be taken out into Sutton or Cheam for other community-based appointments. 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 double bedrooms were occupied by a single person each, and the proprietor made it clear that they were ‘in no hurry’ to fill these two bedrooms with a second occupant, unless it was the current occupant’s wish. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 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 the following 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 religious and cultural needs, where individually expressed / identified. Visitors - especially relatives and friends - 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, 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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 15 The third statement above covers Standard 14 - which was examined at the last unannounced inspection visit, and - from evidence from service users and the owners of the home, was found ‘met’. Newspapers are available at the home through a local delivery – and one service user regularly stretches their legs to get a paper every morning. 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 either communally or in their own rooms. Board games such draughts, cards, ‘Frustration’ and dominoes, alongside Bingo and Quizzes are popular, within a very informal atmosphere of ‘passing the time’. A number of service users enjoy the ‘stretch and exercise’ activity slot. Concerts are also occasionally held at the home – and invitations to local school events are sometimes received and subsequently attended. Service users are encouraged to get out of the building – and indeed, a number of service users were observed to be enjoying their 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 local Surrey Downs are enjoyed – as well as the more occasional summertime trips to the coast. Two service users continue to attend their previously used day care opportunities – this being seen as instrumental to their wellbeing, and part of their care planned support package. Food is provided in service user’s own rooms or in the dining room; though, especially for the main meals, service users are encouraged to ‘come out’ and share food in a more social atmosphere. A service user commented: ‘It’s always served nice and hot - and plenty of it’. The home’s Menu was available on the dining tables – and covered two weeks, including a second option, which service users may opt for. Service users stated that the food was generally in good quantity. The inspector was able to stay with service users during lunchtime and shared some food - the variety and quality being appreciated. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 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 the following 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. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The home has a complaints policy and procedure. No formal com[plaints have been received by the home in the past twelve months. The home seeks to resolve issues at the local level before they become a serious problem / issue. In the past, records evidence that issues have been addressed immediately at the point they arise. A respondent to the Commission’s relative’s questionnaire stated that they were not familiar with the home’s Complaints Procedure; it is recommended that relatives be reminded of the process through the distribution of leaflets concerning this process. 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 Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 17 authority duty teams for referrals to be made – and is held alongside the London Borough of Sutton agreed multi-agency procedure. All staff members at the home have been trained in Adult Protection / Vulnerable Adults issues. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26. The establishment is a safe, well-maintained, clean and homely environment. The home lacks a passenger lift or similar facility, and also requires some remaining radiator surfaces to be covered; both of these must be provided to ensure the home fully meets the ‘older people’ national minimum standard requirements. The home is clean and hygienic, providing all such equipment, now, to ensure that best infection control measures are in practice. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The premises continued to present as a homely and comfortable environment for service users to enjoy as their ‘own home’. All bedrooms seen at this, and previous visits, were individually furnished, warm and welcoming. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 19 The front hallway is now designated as a non-smoking area and this has enhanced the ambiance of the house greatly, meaning that non-smokers no longer have to encounter smoke as they walk through this area accessing different parts / facilities of the house. The proprietors have commissioned an Occupational Therapist report looking at the home from the perspective of the two registration categories – i.e. ‘older people’ and ‘older people with mental health issues (past or present)’. The owners continue to be committed to implementing the remainder of the findings from this report incrementally. A sluice-cycle washing machine has now been installed in the house, thus promoting best practice in infection control measures. The incidence of incontinence at the home, fortunately, continues to be quite low. The new call bell system has ‘bedded in’ well - and is still within its warranty / installation commissioning period. On touring the house, the only issue raised by the inspector was the need for the first floor carpet - especially the first few metres of carpeting - to be replaced before it clearly becomes a trip hazard. This outstanding piece of work is brought forward from the last unannounced inspection visit report. Other outstanding premises issues are of significant scale: The absence of a lift or some form of transportation to the first floor of the home remains an issue - especially in a home registered for older people. The proprietors are, again, required to investigate and consult on the installation of an appropriate solution. Obviously the Fire Safety Officers of the London Fire and Emergency Planning Authority (LFEPA) will also require consultation with regard to such a significant installation within the building. The home has already taken steps to cover an estimated 80 of the hot radiator surfaces around the home. It is now only the communal areas that need still to be completed in this regard; these have been left to last on the basis of ‘lower risk’ relating to active risk assessments. The proprietor indicated that the two above issues were in fact ‘on hold’ - this due to the reduced income - due to the reduced number of service users currently at the home. It is to be hoped that once the [three vacant] single rooms available are occupied, the focus on the above may resume to address these final ‘hurdles’ for the home in achieving a standard that meets all the national minimum requirements. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30. Service users can be assured that staffing is provided at the home in line with agreed, currently adequate, levels. Staff training to NVQ Level 2 or equivalent in Care must continue to be focused upon to ensure 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, with this now being supported by the involvement of an Employments Law & Rights Consultancy practice. Training is provided to staff requiring such input, however the benefits of a formally constructed Staff Training & Development Plan - so as avoiding the current deficit in training of staff in First Aid - is yet to be achieved through a formal workforce development process. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. 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. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 21 Seven staff members have left the home over the past year; two moved away from the area (one to Ireland); two resigned due to other commitments; one moved onto developing their career in childcare and one - a long-term senior member of the night staff, and an instrumental contributor to staff training and support - retired, having worked at the home since 1978. Nine staff members – the more senior on shifts – are in charge of medication, and take charge in the absence of one of the managing proprietors. First Aid was identified as an area where the home must take urgent action to ensure that shifts are covered 24/7 with a duly qualified worker on duty, as a number of qualifications came to an end by the end of November 2006. As a consequence of the departure of the above mentioned care staff, the proportion of care staff qualified to NVQ at Level 2 in care has still not achieved the 50 target which was set for the end of 2005 - this leaving the required standard still unmet. Six staff members have NVQs at Level 2 or above, and four have started on their NVQs - but there is still a time-lapse to go before the minimum competence base is achieved. A minimum of nine qualified staff members is needed to achieve the 50 target. Standards 27 & 29 were found ‘met’ at the last inspection visit - and the judgement statements are reiterated above and reflect this - in the first and third paragraphs. The proprietor was, however, advised to be sure to ensure that during recruitment, minimally one reference is provided from the previous employer of the applicant; and that any gaps in employment prior to their application are also explored. The staff training concern reported in standard 4 is reiterated here - the standard judgement was: “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.” The home is challenged to ensure that increased mental health training input is provided. Staff training provided across the past year included a talk on Anxiety delivered by a mental health professional / Infection Control / Oral Hygiene and Food Hygiene. The home continues to lack a Staff Training & Development Plan – this area of focus was the responsibility of the now-retired senior carer who carried out the majority of the training-related work - and also staff supervision - for the proprietors. This worker’s retirement has left a significant hole in the home’s capacity to ensure a well trained and supported staff team. Such areas clearly now come under the remit of the manager / proprietors and - as such, the proprietors must ensure that these aspects are immediately taken over - either by themselves, or by another responsible senior person. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 36, 37 & 38. The registered manager / owner, though experienced in running care homes, has yet to commence a professional training course to suitably qualify to NVQ Level 4 in Management and Care - now required for competent managers - this leading to deficits in the management processes at the home. The home will benefit by insights afforded by the home’s quality assurance audits of service users and other stakeholders. Such ‘research’ must inform the formulation of a Development Plan and a Business & Financial Plan – both of which are still 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 or ongoing staff meeting / peer support they should have, this due to the permanent loss of a significant senior staff member. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 23 The home ensures that policies and procedures essential for the smooth running of the home are in place - whilst a couple are in need of implementation to fully complete the homes procedures manual. The proprietors generally protect the health and safety of service users and staff, through maintaining the home in a safe and well-serviced state. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The owner / manager and her sister - the co-proprietor, have both intended, in the past, to enrol on a NVQ Management & Care Course to NVQ Level 4 (also known as the ‘Registered Manager’s Award’). To date this has not happened and another college year enrolment has been missed. The home now finds itself with an unqualified manager significantly outside the ‘grace period’ allowed by the minimum national standards. The owners are again challenged - by requirement - to immediately take steps to enrol for a suitable management qualification as soon as is practicable - preferably starting in the New Year 2007. In the more recent past - with regard to staff training, staff support and staff supervision - the proprietors have clearly relied heavily on a senior staff member who was skilled and experienced in these areas (also an qualified NVQ Assessor) and who undertook these aspects on their behalf. This arrangement has now come to an end, due to the retirement of this person, and the management is now confronted with taking over and developing these areas to a competent and adequate level for the present - and into the future. The inadequacies identified in Standards 4, 28 & 30 previously, and also in standards 34 & 36 herein, are attributable to the lack of a person competent in management skills to currently take on developing these tasks. Standard 34 is also not met due to the lack of management knowledge at the home. Another area that requires strong development is that identified in Standard 33 - Quality Assurance (‘QA’) - and the associated forward planning, incorporating the outcomes of consultations and audits undertaken with service users, relatives and stakeholders. A survey format for service users and their families has now been created and will hopefully inform future planning of the service. The resultant Business and Development Plan - which should evolve - and ‘map out’ where a home is heading and state how the goals will be achieved is also absent. The home again sadly fails itself in this regard, as newcomers to the home cannot be clear what the future holds for the home, without clear intentions in this respect being investigated and committed to. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 24 It is good to see the policies and procedures of the home slowly developing into a set of useful and applicable policy statements, though even here the last two policies set by the Commission as ‘standard’ are still not in place. Finances at the home are well maintained; three service users continue to handle their own financial affairs, drawing money and paying their contributions. A further ten service users manage their own financial affairs to varying extents. Five service users are subject to ‘Power of Attorney’. A significant number of service users, however, 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 any service user. Records of financial transactions are suitably kept. Examination of health and safety documentation generally showed adherence to best practice, however the inspector noted that Fire Drills had not taken place formally since 18/04/05 - due to a number (six) of ‘false alarms’ recorded since then. The danger of relying on ‘false alarm’ episodes is that they cannot be planned nor used to observe behaviour or outcomes accurately enough, as they are a surprise to all present. On the other hand, staged fire drills give the management the opportunity to ensure [a] that all staff members are involved over the rolling programme, [b] that learning points are an integral part of the process, and [c] that service user reaction can be properly observed to inform any care planning to respond to their individual needs. The home is required to ensure that Drills are formally held and that they are used to the best purpose possible. Facilities to provide adequate lighting, heating and ventilation are all suitably well maintained – with all documentation relating to servicing and maintenance checks for the home’s equipment being found in order. Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 25 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 2 X X 1 X X 1 3 STAFFING Standard No Score 27 3 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 1 3 1 3 2 Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 26 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 OP4 Regulation 14 Requirement The manager must evidence the mental health skills base of staff at the home to the Commission. (Timescales of 30.10.04, 15.10.05 & 01.05.06 not met.) The worn section of the main corridor carpet on the first floor must be replaced. (Timescale of 01.06.06 not met.) A proposal must be evolved, agreed by the proprietors, and communicated to the Commission as to how they propose 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 Section of the London Fire & Emergency Planning Authority for their comment & support. (Timescales of 30.09.04 & 15.10.05 not met.) All remaining exposed radiators and hot water pipes in the DS0000007164.V311657.R01.S.doc Timescale for action 31/01/07 2. OP19 23(2)(b) 31/12/06 3. OP22 23(2)(n) 31/12/06 4. OP25 13(4) 31/12/06 Linda Lodge Version 5.2 Page 27 communal areas must be protected or replaced with low temperature surface units. (Timescale of 01.06.06 not met.) 5. OP28 18(1) Sufficient care staff must 31/01/07 undertake NVQ training to ensure 50 care staff members are trained to Level 2 in Care, as soon as is practicable. (A recommendation in reports since 2002; a requirement with a timescale of 01.06.06 not met.) A Training and Development Plan 31/12/06 must be devised for the home to indicate the establishment’s commitment to ensuring adequate staff training particularly in mental health issues. (Timescales of 30.11.04, 15.10.05 & 01.05.06 not met.) That First Aid training must be arranged urgently to ensure that shifts are covered 24/7 with a duly qualified worker on duty. 31/12/06 6. OP30 18 7. OP30 13(4) 8. OP31 9(1) (2) The manager / owner(s) must 31/01/07 take steps to qualify to NVQ level 4 in Care & Management, as soon as is practicable. (A recommendation in reports since 2002; a requirement with a timescale of 01.05.06 not met.) A Business and Financial Plan must be put in place, be open to inspection, reviewed annually. (Timescales of 30.11.04, 15.10.05 & 01.05.06 not met.) Formal staff supervision for all staff must be commenced, being of bi-monthly frequency - and providing the minimum content as required by this Standard. DS0000007164.V311657.R01.S.doc 9. OP34 25 31/12/06 10. OP36 18(2) 31/12/06 Linda Lodge Version 5.2 Page 28 (Timescales of 30.10.04, 15.10.05 & 01.04.06 not met.) 11. OP38 23(4) Fire drills - including some staged evacuations - should be undertaken by the home to ensure that staff and service users do not become complacent - due the number of false alarms. 31/12/06 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 OP16 Good Practice Recommendations That relatives be reminded of the Complaint procedure process - through, perhaps, the distribution of leaflets concerning this procedure. That the Access to Files policy is expanded to state more clearly the actual process whereby a service user can see the records pertinent to themselves. That during staff recruitment, minimally one reference is provided from the previous employer of the applicant; and that any gaps in employment prior to their application are also explored. That policies and procedures regarding ‘First Aid’ & the ‘Homes are For Living In’ values-base (privacy, dignity, rights, independence, choice, fulfilment - and including equality) should be put in place. 2. OP18 3. OP29 4. OP37 Linda Lodge DS0000007164.V311657.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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 DS0000007164.V311657.R01.S.doc Version 5.2 Page 30 - 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!