Inspection on 07/06/07 for Linda Lodge

This inspection was carried out on 7th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 05/10/06

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 7th June 2007 11:10a 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.V342443.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.V342443.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.V342443.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. 5th October 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. 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 via 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 this absence limits the use of these bedrooms upstairs to reasonably agile / mobile service users only. Linda Lodge DS0000007164.V342443.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 people about the service - including time spent with one of the registered providers Tina Freed, with care staff members, and talking with a significant number of the people who use the service, and one relative. We examined paper work relating to the building and checked both staff files and files relating to the people who live at Linda Lodge. At the time of the visit, there were twenty people living at the home - the thirteen places allocated to people with a mental health need past or present were full; the thirteen places for people in the pure ‘older people’ category showed a 40 vacancy rate - with only seven people presently placed there. Questionnaires were sent to the four GP practices which serve the home; the majority of them responded positively to the service they experienced / observed in the home. 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: What has improved since the last inspection? Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 6 The home has continued to have bedrooms redecorated and the kitchen has been refurbished. Bedroom windows at the rear of the property upstairs have been replaced and a new bath has been installed in the ground floor bathroom. Following the request for a formal action plan to address the requirements of the last visit, the proprietors have started to formally plan for the future of the home through having a Development / Business & Financial Plan to guide a way forward for the service. This has particularly highlighted the need for staff training - to embed the ethos of the home - and also has sought to consider the aspects of outstanding capital works within the home. 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. The summary of this inspection report can be made available in other formats on request. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 & 6. 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 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. EVIDENCE: The Linda Lodge information brochure contains a sample copy of the Terms & conditions for the home. The home charges a minimum fee of £406 per week (council rate). Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 9 Additional charges are made for: Hairdressing, newspapers, private chiropody, non-NHS dental work, toiletries, holidays, transport and clothing. We continue to express a concern in a repeated requirement - regarding the competence of the home to meet the needs of the ‘specialist’ mental health focus of the service - that accounts for half of the people using the service at the home. The proprietor’s action plan dated 28/02/07 submitted to the Commission, provided in response to the last inspection report requirement, states: “Mental health training. 1 staff ‘Working with women with mental health’ - 2004 10 staff ‘Adult protection’ - 2005 9 staff 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.” We continue to have concerns about the level of competence held by the home to provide this service for people with active mental health issues. The ‘adult protection’ and ‘abuse awareness’ training shown above would be generic in approach, and therefore (though valuable training) would not be directly focused on mental health issues. We were not told of any further recent training courses sourced or undertaken. 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. Standard 6 does not apply to this home - Linda Lodge does not provide an Intermediate Care service. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 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. 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. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 11 EVIDENCE: We spent time checking the case files for two people who currently use the service, which showed that daily records were kept, alongside care plans being in place. It was noted that one care plan had been recently renewed. Holistic annual ‘reviews’ for each person 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’s identified needs. The personal files are 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 and risk assessments were also present. The majority of people at the home continue to be able to help themselves quite substantially in regard to personal care, etc. The manager has estimated that two or three people using the service present with ‘medium’ needs, whilst the majority of seventeen are seen as having low care needs. Only a very few have continence problems - and a similar number were identified requiring help with dressing and personal care tasks. Two service users were suffering pressure area problems at the time of the visit - 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 were able again to observe the storage and administration of medication in practice; staff members gave out medication appropriately and carefully; the process employed was concise and appropriate. Ten staff members - including the proprietors - have been trained in administering the medication; four more recently attended a ‘Safe handling of medicines’ course at Nescot. A complaint concerning maladministration of records by a member of staff had recently resulted in them being removed from the list of those authorised to give medication. This also raised the issue of ensuring regular intensive management audits of the medication processes. Storage and the recording of medication appeared to be appropriately kept, and stocks were well ordered. The hairdresser visits the home once a fortnight and provides a reasonably priced service. Chiropodists from the NHS also visit about three 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 Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 12 visit the home on a regular basis, providing services as required – and people can visit / be taken out into Sutton or Cheam for other external appointments. We noted that people are treated with dignity and respect at the home; all living at the home at the time of the visit 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 with a second occupant, unless it was the current occupant’s wish to ‘have some company’. Linda Lodge DS0000007164.V342443.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 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. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 14 EVIDENCE: The two proprietors have recently attended a training course on ‘Provision of activities in the care setting’ - run by Nescot - in February 2007. 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 a 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. One person attends Woodlands Day Centre three days a week and has a befriender who goes out with them twice a week, whilst another visits an adult education class once a week for art classes (which are thoroughly enjoyed) – this being seen as key to their wellbeing, and part of their support package. 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 – and one service user regularly stretches their legs to get a paper every morning. Relatives and visitors are positively welcomed to the home at any time of the day and all reports speak 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 welcomes religious visitors to visit them privately. People using the service are encouraged to get out of the building and, indeed, a number 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 summer trips to the coast. Food is provided in people’s own rooms or in the dining room; though, especially for the main meals, they are encouraged to ‘come out’ and share food in a more social atmosphere. The home’s Menu is available on the dining tables – and covers two weeks, including a second option, which people may opt for. Dietary preferences can be provided for, but few pursue their cultural / religious perspective. People spoken to have stated that the food is generally in good quantity, and always served ‘hot from the kitchen’. The kitchen has recently been refurbished. One staff member undertook training in ‘Nutrients & health’ in February 2007, and five staff have recently undertaken Food Hygiene training. Linda Lodge DS0000007164.V342443.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, the 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. One anonymous complaint had been investigated concerning the conduct of the home involving a staff member - the proprietors had investigated this, and the complaint was substantiated and disciplinary action was taken and the staff member’s responsibilities curtailed as a consequence. 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. All staff members at the home have been trained in Adult Protection / Vulnerable Adults issues. Linda Lodge DS0000007164.V342443.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, 25 & 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 well-maintained, clean and homely environment. The home lacks a passenger lift or similar facility, and also the Commission requires proferssional confirmation that the remaining exposed radiator surfaces are safe; both of these issues must be addressed to ensure the home fully meets the ‘older people’ national minimum standard requirements and provides a fully accessible and safe environment for the people living there. The home is clean and hygienic, providing all such equipment to ensure that best infection control measures are in practice. EVIDENCE: We found that the premises continued to present as a homely and comfortable environment for people to enjoy as their ‘own home’. All bedrooms seen at this, and previous visits, were individually furnished, warm and welcoming. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 17 The front hallway is now designated as a non-smoking area, and this has enhanced the ambiance of the house greatly. The owners continue to be committed to incrementally implementing the remainder of the findings from the Occupational Therapy report commissioned by the proprietors to look at the home from the perspective of the needs of people falling within the home’s registration categories. Kitchen units have been replaced since the last inspection visit - at the recommendation of the environmental health officer. Some bedrooms have been redecorated. A new bath has been provided in the downstairs back corridor. The windows at the back of the house at first floor level have been replaced with double-glazing units. Also more recently, a sluice-cycle washing machine has been installed in the house, thus promoting best practice in infection control measures. The incidence of incontinence at the home continues to be relatively low. A new call bell system installed last year has also settled in well. The proprietor’s 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.” Miss Freed stated that the owners had put in a bid to gain funding from the local authority ‘Extra Resources Money’ - but were still awaiting an outcome. At the last inspection there was a requirement set to replace a potentially dangerous hazard of fraying hallway and landing carpeting on the first floor. This was due - according to the proprietor’s action plan - to be completed by “April 2007” - on the day of the visit it was ‘on order’ with a flooring company, and Miss Freed assured the inspector that the new surface was to be laid imminently, following the inspection. Another requirement from the previous report related to covering the remaining radiator surfaces that were not low surface temperature units. This is to meet the national minimum standard for care homes for older people. Miss Freed assured the inspector that there were plans to complete this job, (originally projected to “March 2007”) - but that this had not as yet been completed. It has since been agreed that if the remaining exposed surfaces are assessed as ‘safe’ (i.e. low temperature surface units or suitably covered / protected) then written confirmation of these facts must be sent to the Commission by a person so qualified to make this judgement. Linda Lodge DS0000007164.V342443.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, must be focused on 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, ensuring the safety and wellbeing of people using the service. Staff training is provided to staff, however the benefits of a formally constructed Staff Training & Development Plan are evolving and still identifying 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. Seven day care workers cover this daytime task over the seven-day week. Another staff member was being recruited at the time of the inspection. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 19 Six staff have left the home since the last inspection visit - one night staff worker for personal reasons, one senior retired and two other seniors changed career / went back to nursing; two juniors moved onto other career opportunities. For a discussion of the issues raised with regard to mental health-appropriate focus / training, the reader if referred to the first section of this report standard 4. The manager had declared the following as training undertaken in the past twelve months: First aid / Fire training / Continence service update / Safe handling of medication / Nutrition & health / Activities in the care setting / dementia awareness / a talk on Diabetes. Following the requirement raised in the last inspection report, ten staff undertook First Aid training in November 2006. Five staff members have also recently completed Food Hygiene training, and eight (including the proprietors) took part in a Fire Safety course. Training planned for the future included: Food hygiene / Mental health awareness / Medication / Nutrition & health / Infection control. The proprietor’s action plan dated 28/02/07 provided in response to the last inspection report requirement stated that staff supervision was “not started on a formal basis as yet.” And this remained the case in early June 2007, when the co-proprietor conceded that neither supervision nor annual appraisals had been commenced in the home -principally due to short staffing and problems with recruitment following the departure of the five day care staff noted above. We checked three files for newly-started staff members - which showed that all had formally applied for a post using the home’s application form, that references had been taken up for all three, that Criminal Records Bureau (CRB) checks had been undertaken prior to employment, and letters were on file to confirm the contractual agreement. The home is being supported by the involvement of an Employments Law & Rights Consultancy practice. We checked induction records for new staff and found they were poor in content and need developing. One new starter had no record of induction on file, one did have an induction record, and one staff member, it was stated, had taken it home, so it was not available in the house. The Commission expects to find at least 50 staff trained to, minimally, NVQ Level 2 in Care. One night care worker has NVQ at levels 2 & 3; another has NVQ at Level 2. A daytime general assistant is undertaking Level 2 NVQ, whilst Miss Freed and one senior carer have NVQ at Level 2. This represents a figure of less than 30 of the entire care team qualified or a similar figure for the day care workers. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 20 Some staff members have worked for the home from as long back as 1990 nine staff, of the total establishment of 18, have been employed for at least the past five years. One night staff member is currently on maternity leave; the vacancy is covered by staff members who work on a ‘bank’ basis. The proprietor’s action plan dated 28/02/07 provided in response to the last inspection report requirement stated: “By training our staff to a higher level the quality of life for our clients will improve and enhance the ethos of Linda Lodge. Staff self esteem will improve. Hopefully we will have less staff turnover giving our clients continuity and a stable life.” Sadly, it is clear that the home still has some way to go to establish that ethos and stability - rightly identified in this paragraph as having benefits for the people who live there. Staff Training & Development supervision and appraisal was the responsibility of a now-retired senior carer - who carried out the majority of the trainingrelated work and staff supervision for the proprietors. This worker’s departure has evidently still left a significant gap in the home’s capacity to ensure a well trained, supported & developing staff team. This responsibility now comes under the remit of the registered manager / proprietors and they must ensure that these elements are championed either by themselves, or by another responsible and competent senior person. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 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 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, though experienced in running care homes, has yet to commence a professional training course now required for managers - this leading to clear deficits in the 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 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, appraisal or ongoing staff meeting / peer support they should have, this resulting in a less focused service for those living at the home. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 22 The proprietors have routines in place to 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 not at the home during the inspection. Her sister, the second registered provider - Miss Tina Freed, also works full-time at the home in a ‘deputy manager’ capacity, and was covering the management tasks at the home during Mrs Penfold’s absence. Mrs Freed’s brother, Barry Freed, also assists at the home on a regular weekly basis - and is seen as a second Assistant Manager. Other staff roles are then divided into ‘Senior Carers’ and ‘General Assistants’. There are no ancillary staff members provided, so all staff need to have multiple skills, and the management of the service has to build these elements into the daily routine. The proprietor’s action plan dated 28/02/07 provided in response to the last inspection report requirement stated: “The manager does not hold a RMA qualification, therefore will enrol with a suitable college as soon as practicable. The Co-manager is to investigate the possibility of Community mental health care with the view to enrol.” Miss Freed confirmed that Mrs Penfold had enrolled on a RMA Course and that the assessor had visited the home, but that the course proper had not commenced as yet. Miss Freed also stated that it had been suggested that she take the NVQ at Level 3 in Care and undertake the Mental Health options to further her mental health knowledge. This had not been taken up as yet. ‘Quality Assurance’ at the home had taken a step forward with the introduction of questionnaires for service users and stakeholders. It is hoped that the outcome of such surveys would feed into 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 no subsequent ongoing monitoring. Meetings for those who live at the home have also ceased to operate, this removing an important decision-making process from those who live at the home. Administrative measures - such as the home having a current insurance certificate for employer’s liability through to 2008 - were in place. Three people who use the service continue to maintain their own benefits and account books, whilst a further ten manage their own financial affairs. Six people resident at the home are under a Power of Attorney. General financial records operated by the home appeared to be in order. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 Page 23 We found that records of some of the basic weekly health & safety checks showed that they had inexplicably discontinued, and needed urgent revival; the fire alarms were checked - and this was recorded - prior to the inspector leaving the home on the day of the visit. Fire drills also continue to be an issue where vigilance is needed to ensure that all staff members experience the reality of such a rehearsal - ‘false alarms’ are not to be relied upon, as they are not structured learning experiences. This is an example of the loss of management overview - quite possibly due to the pressure on the managers to augment care staff activities. Contracts concerning lifting hoists, the disposal of hazardous waste, and the checking of emergency systems otherwise were found to be in order. We found that in a sluice area, both bottles of ‘Domestos’ bleach and liquid ‘Flash’ were both openly available in a bucket - not locked away, as would be required under the Code of Practice relating to hazardous chemicals (COSHH). Again the lack of management observation / vigilance was evident. Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 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 1 3 STAFFING Standard No Score 27 2 28 1 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 1 X 1 Linda Lodge DS0000007164.V342443.R01.S.doc Version 5.2 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 OP4 Regulation 14 Requirement The manager must evidence the developing mental health skills base of staff at the home to the Commission. (Previous timescales - since 2004 - not met.) Timescale for action 31/10/07 2. OP22 23(2)(n) 31/10/07 A proposal must be evolved, agreed by the proprietors, and communicated to the Commission as to how they propose to ensure that a lift to the first floor level of the home is provided. Such plans must also be submitted to the Fire Safety Section of the London Fire & Emergency Planning Authority. (Timescales - since 2004 - not met.) All remaining exposed radiators and hot water pipes in the communal areas of the home must be assessed and expert confirmation that all pipework and surfaces are safe must be sent to the Commission. (Timescale to fully meet this standard set since 01.06.06.) DS0000007164.V342443.R01.S.doc 3. OP25 13(4) 31/10/07 Linda Lodge Version 5.2 Page 26 4. OP28 18(1) Sufficient care staff must take training to ensure minimally 50 care staff members are trained to NVQ Level 2 in Care. (A recommendation in reports since 2002; a timescale set since 01.06.06 not met.) A Training & Development Plan must be devised to indicate the establishment ensuring adequate staff training specifically in mental health issues. (Timescales set since 30.11.04 not met.) Induction records must be revised to ensure that an adequate process [to Skills for Care standard] and including all local information, must be devised and fully implemented with new and existing staff. The manager / owner must evidence the steps taken to qualify to NVQ Level 4 in Care & Management, (‘RMA’). (A recommendation in reports since 2002; a requirement since timescale of 01.05.06 set.) Formal staff supervision for all staff must be commenced, being of bi-monthly frequency - and providing the minimum content as required by this Standard. (Timescales since 30.10.04 not met.) Annual appraisals of staff must be commenced to enable a focused approach to staff development and retention. Regular planned Fire Drills must be undertaken by the home to ensure that staff and service DS0000007164.V342443.R01.S.doc 31/12/07 5. OP30 18 31/12/07 6. OP30 17(2): Sch 4.6(g) 31/12/07 7. OP31 9(1) (2) 31/10/07 8. OP36 18(2) 31/10/07 9. OP36 18(2) 31/12/07 10. OP38 23(4) 31/10/07 Linda Lodge Version 5.2 Page 27 users are all conversant with the procedure. 11. OP38 13(4)(a) (c) Fire alarm checks must be undertaken on a rigorously weekly basis and formally recorded. Management audits must ensure that such important issues are not neglected. Issue raised and addressed at the time of the inspection visit. 07/06/07 12. OP38 13(4)(A) (c) Hazardous chemicals and other 07/06/07 substances must be kept secured away from the risk of misuse at all times. Management audits must ensure that such important issues are not neglected. Issue raised and addressed at the time of the inspection visit. 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.V342443.R01.S.doc Version 5.2 Page 28 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.V342443.R01.S.doc Version 5.2 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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