Inspection on 06/11/05 for Lloyd Lodge

This inspection was carried out on 6th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Lloyd Lodge 21/07/08

Lloyd Lodge 10/07/07

Lloyd Lodge 22/02/07

Lloyd Lodge 22/06/05

Lloyd Lodge 24/02/05

Lloyd Lodge 09/07/04

Lloyd Lodge 16/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Lloyd Lodge 2 St Georges Road Bedford Bedfordshire MK40 2LS Lead Inspector Georgia Chimbani Unannounced Inspection 6th November 2005 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 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. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Lloyd Lodge Address 2 St Georges Road Bedford Bedfordshire MK40 2LS 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) 01234 268757 01234 272927 Lloyd Lodge Limited Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18), of places Physical disability over 65 years of age (18) Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. There are no conditions associated with this registration Date of last inspection 22nd June 2005 Brief Description of the Service: Lloyd Lodge is situated in a pleasant residential suburb of Bedford. The home has been registered to the current owners since 2001, and is registered for 18 service users over the age of 65 years with a diagnosis of dementia and/or physical disabilities. The bedroom accommodation is on three floors. Currently in use as bedrooms are twelve single, and two double rooms, all with ensuite toilet facilities. There are two lounge/dining areas on the ground floor, and all floors are served by a lift. The home has a garden at the rear accessed by a ramp. The home is in within walking distance of a park, a local bus route and Bedford Town centre. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Sunday morning and lasted 4 hours. Present at the inspection was the deputy manager Ms Sharmila Kale. The manager Ms Sue Sylvester and the owner Ms Prema Hepworth arrived at the home after the inspection had commenced. The home is registered for 18 service users although at present there is room for 16 service users in the home. The owner informed the inspector that there are plans to extend the home to create another two bedrooms. Individual and group interviews were held with 4 service users. Feedback on the quality of care offered by the home was positive. Following the last inspection two recommendations were made relating to the availability of a cook at weekends and the recruitment of an activities Co-ordinator. There was evidence to indicate that progress has been made towards meeting these recommendations. No requirements were issued at the last inspection. At this inspection 12 requirements were made. The inspector is confident that compliance will be achieved within the timescales set by the CSCI. What the service does well: What has improved since the last inspection? The home now has a cook to prepare meals over the weekend to ensure consistency in the quality of food. An activities co-ordinator is still to be recruited however service users are offered a range of activities and records are maintained of all activities. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 6 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. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 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 Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The lack of comprehensive pre-assessment information casts doubt on the home’s ability to meet the needs of service users. EVIDENCE: Three files were examined of service users who had been admitted to the home in the last few weeks. One service user had a comprehensive preadmission assessment while pre-admission information was incomplete for two service users. For instance the records of a service user who had moved into the home at the beginning of the week contained no details of the date of admission, allergies and their next of kin. This information forms part of the home’s pre-admission assessment. The registered persons must ensure that comprehensive pre-admission assessments are available for all service users before their admission to the home. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 10 and 11 Care plan documentation must be improved to ensure that the home can meet service user’s needs. The lack of consultation with service users does not give them the assurance that their wishes are respected. Service user’s dignity must be upheld at all times to give them confidence and promote good relations with staff. EVIDENCE: Care plans of the service users referred to in standard 3 were examined. Two files contained comprehensive care plans with evidence of regular and recent reviews. A service user admitted to the home for two weeks respite had an incomplete care plan. The care plan seen described the service user’s needs relating to eating and drinking and nothing else. The manager advised the inspector that the respite care had been arranged in order for the service user’s dietary needs to be closely monitored. The inspector was of the opinion that although dietary needs were the main focus of the service user’s care plan, other needs had to be identified and recorded. For example the care plan contained no information on how needs relating to mobility, personal care and Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 10 social interests would be met. Another service user was described by staff as experiencing continence problems but this was not reflected on the recent care plan review. There was evidence that service users had been consulted on admission regarding preferred times for waking up or going to bed, bath times and frequency, religious needs and the gender of staff who would assist them with personal care. There was however no evidence that service users had been involved in the compilation and review of their care plans. One file contained evidence of service users consultation but this had been done soon after their admission and not on a regular basis. The inspector queried how effective the home would be in meeting the needs of the service user on respite requiring dietary support if they did not involve them in their care. Photographs of service users were missing from two files. The registered persons must ensure that service user care plans contain comprehensive information on their needs and a recent photograph. There must be evidence of regular consultation with service users. Risk assessments were not seen on the 3 files examined. There were however dependency profiles that gave scores on service user’s levels of ability in areas such as mobility and personal care but these gave limited information. For example one service user was assessed as being of medium dependency but there was no information on the strategies to be taken to minimise the identified areas of risk. This service user was described as chair bound with limited mobility but no moving and handling and pressure area risk assessments were available. This is required. Two of the three files viewed did not contain information on service users wishes in the event of their death. This is required. Interviews with service users revealed that staff treated them with respect however observations by the inspector during the course of the inspections showed that more could be done maintain the privacy and dignity of service users. During a tour of the home at the start of the inspection, the inspector was led into a double room on the ground floor leading from the main lounge. A service user was asleep in bed with the door wide open. The deputy manager did not knock before entering and seemed unaware of the inappropriateness of inviting the inspector to view this room with the service user still in bed. Although the inspector left the room immediately, confirmation by a member of staff to the deputy manager that the room had already been cleaned although the service user was still in bed caused further concern. During lunch a service user was observed eating their lunch with no great difficulty at a pace that suited them. The deputy manager with no consultation with the service user took their cutlery, cut up their food and proceeded to feed them while making remarks about the service user’s feeding abilities to the inspector. The inspector was concerned that the deputy manager did not ask the service user if they wanted assistance and made no attempts to give assistance in a way that maintained their respect and dignity. The registered person must ensure that all service user work in a way that upholds the dignity of service users. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Service user’s dietary and social care needs are being met by the home. EVIDENCE: At the previous inspection, two recommendations were made for the registered persons to consider employing an activities co-ordinator to facilitate activities and a cook to work over the weekends. The manager informed the inspector that an activities co-ordinator had not been recruited yet but the owner was planning to do so. The manager keeps records of activities held daily and service users who participate in these activities. This information is them compiled monthly to give a monthly summary of activities individual to each service user. These records were available for inspection and revealed that service users were engaged in a variety of activities. Before lunch was served service users were observed singing hymns and their level of enthusiasm indicated that this was something they enjoyed doing. Conversations with management indicated that a cook was now available to prepare meals at the home over the weekends, however on the day of the inspection the cook was away due to personal reasons. The inspection commenced in the morning after the majority of service users had eaten breakfast however the inspector observed some service users eating breakfast at times convenient to them. Service users interviewed told the inspector that they were happy with the breakfast provided by the home. The inspector was able to observe service users eating lunch. The food was well presented and service users gave Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 12 favourable comments about it. When asked their general opinion about the food offered by the home, one service user described the food in the home as “ordinary” another told the inspector that they never knew what they were going to eat until it was on their plate. They just “hoped for the best and sometimes it works.” A tour of the kitchen revealed that there were sufficient quantities of fresh and frozen food in the home. Bottles of sauces stored in the fridge were not dated. The registered persons must ensure that foods with a limited shelf life are dated. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 13 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 and 18 The lack of a complaints record means that service users and their relatives do not have confidence that their complaints will be taken seriously. The lack of satisfactory adult protection procedures has left service users with little protection from harm and abuse. EVIDENCE: The inspector was shown the complaints policy on file. The policy on file did not clearly show ownership by the home. It had the name “Health Authority” followed by the name of the home. This policy did not contain the details of the CSCI and mentioned referral to UKCC and FHSA as part of the complaints procedure. Following discussion with the manager, the inspector was shown the complaints policy displayed in the home. This was assessed as satisfactory and contained the required information. The registered persons must ensure that there is consistency in the complaints information available to service users and staff in the home. All complaints policies must show ownership by the home and include the contact details of the CSCI. The complaints record was requested but it was not available. The manager advised that only two complaints had been received by the home in the past year. One complaint had been recorded on the file of the service user who made the complaint and the other relating to the performance of a member of staff had been file separately. On closer examination of the nature of the tow complaints, the inspector noted that the complaint regarding the performance of a member of staff had involved an allegation of abuse of a service user. Following an internal investigation by the home and disciplinary procedures, the member of staff had been dismissed. The inspector was concerned that no adult protection Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 14 procedures had been followed despite the clear risk to service users. Through discussion the manager seemed unsure of adult protection procedures. The inspector viewed that home’s adult protection procedures and found them to be misleading in the action to be taken and the role of the local authority and the CSCI were not clear. The registered persons are required to ensure that the adult protection policy and procedures are reviewed in accordance with local authority procedures. These procedures must be implemented in instances where allegations of abuse of service users are made. The registered persons must ensure that all staff working in the home are familiar with the revised adult protection procedures. The registered persons must ensure that all staff working in the home are familiar with the revised adult protection procedures. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 15 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, 21, 22, 24, 25 and 26 The home provides a safe and welcoming environment for service users. The elimination of offensive odours and maintenance in some areas is required to ensure a consistently comfortable environment for all. EVIDENCE: During a tour of the home the inspector noted that the home is well furnished and brightly decorated however some areas were identified as requiring maintenance. The hallway carpet near the laundry room must be replaced and the flooring at the laundry entrance repaired. There was evidence that some service users had furnished their bedrooms with personal items of furniture. One service user who had moved into the home recently told the inspector that they were waiting for some personal items to be brought to the home by their family. Radiator covers were seen around the home. A high standard of hygiene was observed around the home. The home was largely free of offensive odours except for one service user’s room. The flooring in this service user’s room must be replaced. The home has two assisted baths and two bedrooms have en-suite shower facilities. A hoist was seen in the home. The deputy manager informed the inspector that at present this was used for two Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 16 service users. An interview with one of the service users requiring hoisting revealed that staff sometimes used a manual handling belt to transfer them from their chair. The service user stated they felt safe and comfortable with this method of transfer and added, “it gets the job done.” Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 17 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): EVIDENCE: Standards 27 to 30 are key standards that must be inspected at least once during a 12-month period. These standards were assessed and met at the last inspection and have therefore not been assessed at this inspection. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 18 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): 37 and 38 The existence of relevant polices and procedures demonstrates the home’s commitment to ensuring service users’ rights to access their personal information. The health and safety of service users must be promoted through regular health and safety checks. EVIDENCE: The home has a policy on confidentiality and resident’s access to their personal files. The inspector was able to view these policies and confirmed that they contained details on how the home would store and share information relating to individual service users and how service users could access the information held about them by the home. Documentation was seen confirming that recent checks had been carried out on the fire alarm system, wheelchairs, assisted baths and shaft lift. Checks are due to be carried out on fire extinguishers, call system, gas and electrical installations. Records of weekly fire alarm tests and Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 19 fire drills were not available. The manager believed these to be with the maintenance man who was not on duty at the time of the inspection. The registered person must ensure that documentation confirming up to date and satisfactory health and safety checks is available in the home at all times. Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 20 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 X 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 3 3 X 3 3 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X 3 2 Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14(1) Requirement The registered persons must ensure that comprehensive preadmission assessments are available for all service users before their admission to the home. The registered persons must ensure that service user care plans contain comprehensive information on their needs and a recent photograph. There must be evidence of regular consultation with service users. The registered person must ensure that all service user work in a way that upholds the dignity of service users. The registered persons must ensure that service user’s wishes in the event of their death are recorded. The registered persons must ensure that foods with a limited shelf life are dated. The registered persons must ensure that comprehensive risk assessments are available for all service users including clear strategies on how to minimise DS0000014931.V260464.R01.S.doc Timescale for action 06/02/06 2 OP7 15 06/02/06 3 OP10 12(4)(a) 30/12/06 4 OP11 12(3) 06/02/06 5 6 OP15 OP7 13(4)(c) 13(4) 30/12/05 06/02/06 Lloyd Lodge Version 5.0 Page 22 7 OP16 22 8 OP18 13(6) identified risks. The registered persons must ensure that there is consistency in the complaints information available to service users and staff in the home. All complaints policies must show ownership by the home and include the contact details of the CSCI. The registered persons are required to ensure that the adult protection policy and procedures are reviewed in accordance with local authority procedures. These procedures must be implemented in instances where allegations of abuse of service users are made. The registered persons must ensure that all staff working in the home are familiar with the revised adult protection procedures. The registered persons must ensure that the flooring at the entrance to the laundry room and in the toilet of a named service user’s room is replaced. The hallway carpet near the laundry room must be replaced. The registered persons must ensure that offensive odours are eliminated in the bedroom of a named service user. The registered person must ensure that documentation confirming up to date and satisfactory health and safety checks is available in the home at all times. 06/02/06 06/02/06 9 OP18 13(6) 06/02/06 10 OP19 23(2)(b) (d) 06/02/06 11 OP26 16(2)(k) 06/02/06 12 OP38 13(4)(c) 23(4) 06/02/06 Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 23 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 Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Lloyd Lodge DS0000014931.V260464.R01.S.doc Version 5.0 Page 25 - 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. 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