Inspection on 01/06/07 for Lodge (The) Collier Row

This inspection was carried out on 1st June 2007.

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

Lodge (The) Collier Row 30/01/06

Lodge (The) Collier Row 03/10/05

Lodge (The) Collier Row 17/02/05

Lodge (The) Collier Row 03/08/04

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 Lodge (The) Collier Row Lodge Lane Collier Row Romford Essex RM5 2HX Lead Inspector Jackie Date Unannounced Inspection 9:15 1st – 8th June 2007 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 Lodge (The) Collier Row DS0000027862.V337751.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. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lodge (The) Collier Row Address Lodge Lane Collier Row Romford Essex RM5 2HX 01708 732293 01708 781122 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) Mr Ian George Nicoll Mrs Patricia Constance Nicoll Care Home 63 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (63) of places Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation to residents of both sexes whose primary care needs on admission to the home are within the following categories:Old age not falling within any other category (Category OP) (no more than 63 persons) Service users with dementia who are over 65 years of age (Category DE(E)) (no more than 40 persons) The maximum number of service users who can be accommodated is 63 30th January 2006 2. Date of last inspection Brief Description of the Service: The Lodge is situated in Lodge Lane, which is close to Collier Row, where there are shops, cafes and restaurants. There is easy access to local towns such as Romford and Ilford. A bus stops directly outside the home. Thirty of the 62 bedrooms are ensuite, and the one double room is only used as such on request. The communal areas consist of three well-furnished lounges on the ground floor with one lounge on the first floor. There are two spacious dining rooms to cater for the differing needs and choice of the residents. The home is decorated and furnished to a high standard throughout. The home caters for residents over the age of 65 and has recently changed its registration to accommodate up to 40 people with dementia. The home is one of five homes privately owned by the organisation and managed by one of the proprietors with the assistance of an experienced staff team. Personal care is provided on a 24-hour basis, with health care needs being met by visiting professionals. The home is accessible to wheelchair users. There is a well kept garden that some of the residents enjoy sitting in. Bathing and toilet facilities are suitable for the needs of older people. The residents enjoy a range of activities such as music, games, arts and crafts, gardening and entertainment. The fees per week for each resident are between £493-00 & £575.00. This information was provided in the pre inspection questionnaire received in May 2007. Information about the service provided is contained in the service users’ guide and residents’ welcome information pack. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the course of two days. The first day of the inspection was unannounced and started at 9:15. It took place over eight and a half hours. A second arranged visit took place the following week. The purpose of this was to be shown around the home by residents and then to meet a group of residents to get their views on the service and their experience of living in the home. Also to meet the manager and to access staff files. On the second day a specialist pharmacist inspection was carried out and the report from this visit is included in the section relating to medication. Care staff were asked about the care that residents receive, and were also observed carrying out their duties. All of the shared areas and some of the bedrooms were seen. Staff, care and other records were checked. Feedback questionnaires were sent to residents, relatives and staff. Responses were received from 23 residents and also from 1 staff. Feedback was also received from 2 visiting healthcare professionals. The contract-monitoring officer for the local authority was also contacted for feedback. Relatives were spoken to during the course of the visits. This was a key inspection and all of the key inspection standards were tested. The inspector would like to thank the residents and staff for their input during the inspection. What the service does well: The contracts monitoring officer from the local authority said, “With regards to the Lodge - it is a lovely home environmentally and they have a very flexible approach towards residents, giving them autonomy in making decisions over their lives. I think that it is a good home.” Residents said, “I am happy here”, “you are so very well looked after”, “the staff are kind”, and “this is a caring home”. Relatives said, “the staff can’t be faulted”, “its very clean”, “this is a nice comfortable place, everyone is kind, my mother is well looked after”, “it is wonderful here”, “the staff are kind and patient, and there is continuity of care”. The GP said, “ I am very happy with the care that residents receive”. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 6 The staff team are experienced and receive the training that they need to provide a good service for the residents. They work very hard to provide a good service even though there have been staff shortages. The manager and senior staff welcomed feedback from the inspector and showed willingness and commitment to address requirements as soon as possible. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lodge (The) Collier Row DS0000027862.V337751.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 Lodge (The) Collier Row DS0000027862.V337751.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): 1, 2, 3 & 5. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Prospective residents and their relatives are provided with sufficient information to enable them to make a decision about living in the home. Information is obtained to enable the staff team to decide whether or not the home can meet prospective residents’ needs. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so, and to be confident that the home meets their needs. Residents and their representatives have a written and costed contract/statement of terms and conditions and will therefore be clear about what they are entitled to. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 9 EVIDENCE: There is a Statement of Purpose & Service Users guide. These were updated earlier this year to reflect the change in the homes registration category to include people with dementia. They both contain appropriate information to enable prospective residents and their relatives to make a decision about living there. Therefore appropriate information about the home is available to prospective residents and their relatives. It is recommended that a service user guide in a pictorial format for the benefit of some of those people living with dementia, be developed. Individual records are kept for each resident and a number of files were examined. These included the files of new residents. All records inspected had assessment information recorded and the information had been used to continue assessments following admission to the home, and to develop written care plans. The inspector was satisfied that a full assessment of need is undertaken prior to residents moving into the home, and that the manager would not admit a new resident unless she was sure that the assessed needs of the individual could be met. Prospective residents and/or their relatives are provided with information about the home and encouraged to visit before making a decision about living in to the home. Some residents spoken to said that they had looked round the home before they moved in. Each resident has a contract with the provider and a copies were seen in files inspected. The contract indicates what the fees cover and what is not. The home does not provide intermediate care. Lodge (The) Collier Row DS0000027862.V337751.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 & 11. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents’ health and personal care needs are set out in individual care plans that reflect their needs. Care plans provide staff with sufficient information to ensure that care needs are being met on a daily basis, but this information is not necessarily always up to date. Residents receive personal care that meets their individual needs and preferences. The principles of respect, dignity and privacy are put into practice. Residents receive good quality health care. Although residents receive good personal and healthcare staffing levels do not always allow for staff to spend as much time with residents as they would like to. This can therefore sometimes limit resident’s choices. Medication administration and medication records need to be more robust to ensure that residents receive their prescribed medication as safely as possible. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 11 EVIDENCE: All of the residents have care plans, which give details of their needs and how to maintain their independence as far as possible. This includes health and personal care. They also contain information about residents’ likes and preferences. For example one resident’s plan says that she does not eat breakfast but likes to have a couple of biscuits with a cup of tea. Another’s indicates that she is aware of the monthly church service and will decide on the day whether she wishes to attend or not. Residents and /or their relatives are encouraged to read and sign the care plans and evidence of this was seen in resident’s files. The staff team has not regularly reviewed care plans. From discussions with staff this would seem to be related to staff shortages and staffing levels. It is very important that information about residents is reviewed regularly and updated as necessary to ensure that the staff team have the correct and up to date information about resident’s needs and how to meet them. Residents care plans must be reviewed by care staff at least once per month, updated to reflect changing needs and current objectives for health and personal care, and actioned. The home is now registered to provide care to people with dementia. To assist staff to support those residents appropriately they have all completed a distanced learning dementia course and staff spoken to said that this gave them a lot of information about working with people with dementia. In addition the ancillary staff received dementia awareness training. Feedback from relatives was that residents are well looked after, and staff are kind and patient. Some relatives commented that staffing could be a ‘bit tight’, especially in the evenings. Feedback from residents was that staff work very hard and are helpful. Also that staff are sometimes very busy but will always help you and they are pleasant. One resident said, “staff are good to me”, another said “everyone always has a smile for you”. A resident said, “I have not lived here for very long but it is a brilliant place and I would rather stay here than go home with carers coming in”. It was evident from talking to residents and from observing staff with residents that they receive good care. One resident said, “they always watch out for me to make sure that I am alright”. At lunch time a resident wanted to use the toilet. A member of staff assisted him to the toilet, and then waited outside. After a short while the member of staff then went into the toilet again to give the gentlemen the assistance that he required as well as giving him some privacy when using the toilet. However from discussions with staff and from the rota it was evident that staffing levels mean that staff do not have as much time with residents as they would wish and that sometimes this can mean that residents feel rushed. The section on staffing gives more information and requirements with regard to staffing levels. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 12 Staff talked about and were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as the way they addressed residents and were observed knocking on bedroom and bathroom doors before entering. Feedback from the Local Authority Contracts Monitoring officer was “they have a very flexible approach towards residents, giving them autonomy in making decisions over their lives.” Residents are registered with local GPs. The optician, dentist and chiropodist make regular checks. Medical information is recorded and the outcome of visits to the doctor or hospital and any follow up action is recorded. Evidence of this was seen in resident’s files. The district nurse visits as and when required to provide nursing support. Feedback form a district nurse was that residents receive very good care and are well looked after. Staff know residents well and call district nursing for support with appropriate issues. She also said that she felt that residents are treated very well. One of the local GP’s was visiting the home and he said that he had been visiting for about 2 years and approximately half of the residents were registered with his surgery. He has a regular surgery at the home. The doctor said that the staff know about the residents and that they will raise issues and concerns with him. They use the out of hours service appropriately. He went on to say that he was very happy with the care that the residents receive and that their appearance and cleanliness were good. The doctor said he did not have any concerns about residents care. He also said that staff raise any concerns about medication and have a good working relationship with the chemist. Details of residents’ wishes in the event of their death are recorded in care plans. This information is usually about whether a person wishes to be cremated or buried and gives the name of a funeral director. The importance of developing these further was discussed with the manager, during the inspection. As a result of this the home has produced some information about end of life care that they are going to give to residents and their relatives to assist them to obtain more information about individuals wishes as sensitively as possible. Residents who are at the end of their life are supported in the home, as far as is possible, with input from the district nurse or palliative care team. At the end of their life residents are supported kindly and sensitively. An announced inspection was conducted on 8.06.2007 by a CSCI pharmacist inspector (PI) following a referral from the home’s regulatory inspector. The findings of the pharmacist inspector are as follows. The temperature of medicines stored in the medicines fridge was neither monitored nor recorded to ensure that medicines maintain their stability and therapeutic effect in accordance with the medicines licensing requirements. A maximum/minimum thermometer is required to be installed to monitor the temperatures and the max/min temperatures to be recorded daily. An Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 13 immediate requirement notice was issued. This requirement was addressed before the completion of the inspection process. In common with all medicines storage, the medicine fridge must be kept locked to prevent unauthorised access and misappropriation. This was not the case. However this was rectified before the completion of the inspection process. The eye drops in use that were stored in the medicines fridge required the date of first opening entered on the container to ensure usage does not exceed the in-use shelf life. Once the eye drops indicated during the inspection are in-use they should be stored at room temperature to improve the administration to residents. The medicines policies & procedures required inclusion of the requirements for the cold storage of medicines, including the monitoring requirements. The security of the medicines cupboard located in a communal corridor was inadequate and required securing with a good quality lock to prevent unauthorized access and misappropriation. An immediate requirement notice was issued. This requirement was addressed before the completion of the inspection process. The audit of medication indicated two medicines where the quantity found did not agree with the records of receipt and administration. If records are correct then discrepancies found by audit act as an indicator of occasions when carers may be signing for administration when a dose is not given, resulting in a surplus, or in the case of a deficit, giving too much medication. In the case of exceeding the prescribed dose this could result in a resident experiencing adverse effects of a medicine, or in the case of under-dosing would reduce the medicine’s therapeutic effect on a resident. Without this reliable information a resident’s symptoms may be interpreted as a change in the course of their medical condition, resulting in unnecessary and inappropriate treatment, or prescribing a change of dosage or change of medication, which may harm the resident. Attention is therefore required for the audit of medication to be able to reconcile the records with the quantity available and to account for the blank entries for dose administration on the medicines administration record (MAR) charts. A medicine (finasteride) requiring handling precautions to avoid the risk of adverse effects to the handler was being administered to one resident. For the protection of care staff the home requires a documented policy & procedure and care staff are to be made aware of medicines requiring handling precautions. In view of the difficulty in establishing the audit of a schedule 2 Controlled Drug (CD) (morphine sulphate 10mg. tablets) it is required to keep CD in the CD cupboard available in the home. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 14 In accordance with the advice from the Committee on Safety of Medicines, as indicated in the BNF in the section on atypical antipsychotics (4.2.1), the MHRA notification dated 9 March 2004 “New advice issued on risperidone and olanzapine (reference 2004/0095)” and the licensed contraindications. Attention is requested to reviewing the prescribing of risperidone for residents diagnosed with a dementia. When medicines are prescribed with directions for administration on a when required basis or with non-specific directions, e.g. to be taken as directed, documented guidance is to be available with the medicines administration record (MAR) chart to ensure medicines are correctly administered. This includes such guidance as when to administer, frequency, maximum repeated dosing, etc. Details of this requirement are to be included in the medicines policies and procedures. To provide clarity of directions for the administration of anticoagulants at the point of medicines use it is recommended to keep the anticoagulant clinical monitoring information (yellow book) with the relevant medicines administration record (MAR) chart. Further safety information on the safety of anticoagulants can be found on the National Patient Safety Agency website http:/www.npsa.nhs.uk/site/media/documents The entries that staff need to write on residents’ medicines administration record (MAR) charts, e.g. indicating changes or discontinuation, require their signature or signed initials and the date of the entry together with brief details or reference to another document containing details e.g. district nurse records, for the purposes of accountability. The home’s policy/procedure for medicines taken out of the home by its residents requires the inclusion of documentation to account for medicines leaving and returned to the home. It is recommended to review, update and collate the home’s medicines policies & procedures taking into account the information provided in the CSCI Professional Advice documents and that of the Royal Pharmaceutical Society including: • Medicine administration records (MAR) in care homes and domiciliary care. CSCI • The administration of medicines in care homes. CSCI • Training care workers to safely administer medicines in care homes. CSCI • The safe management of controlled drugs in care homes. CSCI • The Administration and Control of Medicines in Care Homes and Children’s Services. The Royal Pharmaceutical Society of Great Britain. To provide a useful working document it is recommended that the sections be brought together into a single document with improved indices to provide for Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 15 ease and speed of reference and to be made available at the point of medicines usage. To avoid the risk of staff acting on outdated information it is recommended to remove the March 1999 edition of the British National Formulary (BNF) leaving the more recent September 2005 edition available for reference. A new edition is published every 6 months and copies may be obtained direct from: RPS Publishing, C/O Turpin Distribution, Stratton Business Park, Pegasus Drive, Biggleswade, Bedfordshire SG18 8TQ, Tel: 01767 604971, Fax: 01767 601640, Website: www.pharmpress.com Email: custserv@turpin-distribution.com To facilitate the assessment of medicine therapy it is required to document the reason for dosage omission on the medicines administration record (MAR) chart when entering the undefined omission code “O”. It is recommended that the home’s policy & procedure for dealing with errors in the administration of medicines includes reference to the action to be taken when staff are unable to immediately contact a resident’s GP. Details for contacting NHS Direct would be helpful in this situation to avoid any unnecessary delay in obtaining a health professional’s advice. To avoid the use of medicines beyond their in-use expiry a policy and procedure is required providing guidance to the home’s staff for the stock control of medicines with a limited in-use shelf life. A guide policy and procedure for the stock control of liquid medicines was given during the inspection. The simple linctus, kept by the home as a homely remedy, may have been in use beyond its in-use shelf-life as there was no date indicating when first opened. The good practice of entering the date of first opening should be applied to any medicine where usage may go beyond the in-use shelf life. It is recommended that the use of lactulose on a when required basis to relieve the constipation of residents (SU) be reviewed by their GP. The mode of action of this laxative normally requires 2 to 3 days for therapeutic effect and is therefore unsuitable for intermittent use. Prescribing for constipation should be reviewed and if a laxative is still required on a when required basis, either with or without regular administration of lactulose according to individual resident requirements, then a stimulant or mixed action laxative may provide more effective therapy, e.g. magnesium hydroxide mixture or senna. BNF section 1.6.4 refers Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 16 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, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents are able to make informed choices about their what they do and how they spend their time. Residents have the opportunity to join in a range of activities and this is being developed and extended. Visiting times are flexible and visitors are welcomed in the home and residents can keep in contact with friends and relative. The meals in the home are good and residents have a choice of what to eat. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 17 EVIDENCE: Activities are organised each day and these include crafts, music, sing-a longs, quizzes, bingo, reminiscence and pampering sessions. The new activity coordinator works for 6 hours per day from Monday to Friday. This person is an experienced activity worker and also specialises in activities for people with dementia. The coordinator said that she is getting to know the residents and is gradually developing the role. She had attended the most recent residents meeting to introduce herself and to ask for ideas and suggestions. There are pictures of various activities and residents said that recently they had helped to plant some pots for the garden and also to make things for the Summer Fete. Feedback from staff was that the new activity person was very good and that residents are getting involved. In addition there is a part time activity worker who organises the entertainment. Each month a professional entertainer visits the home and residents said that these are always very good. Recently the home held a birthday party for a lady who was 104. During one of the inspection visits a birthday party was being held for another resident and staff had worked with the family to organise some surprises. Her favourite entertainer had been booked and one of her daughters, who lives some distance away, was make a surprise visit. There is also a monthly church service held by people from the local gospel church. They visit and also bring some children with them. The church group are also invited to join residents for a strawberry tea. Some of the residents spoken to said that they like to go to the church service. Therefore residents spiritual needs are met. Visitors are always welcomed and friend and families are invited to all the celebrations. Relatives spoken to said that the staff are friendly. Residents are encouraged to be as independent as possible and to be involved in choices about the home and about their lives. Residents’ meetings are held and residents are asked for their opinions and ideas. For example about activities, food and colour schemes. Residents were observed to move freely around the home. Some like to spend time in their rooms but most prefer to spend time in the lounge or when weather permits, the garden. Some of the residents help to lay the tables and prepare the dining area for meals. They said that they really enjoyed doing this and that they liked to be useful. The dining tables were all very nicely laid with tablecloths, flowers, cruet and napkins. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 18 There are two dining rooms and both of these are used at mealtimes. People that need a bit more support tend to use the smaller dining area. Residents are offered a choice of meals and the menu is varied. Special diets can also be catered for and also different types of meals. At present none of the residents have any special dietary requirements. Most of the food prepared is home made. Residents spoken to said that the food was good and confirmed that they get a choice. The inspector had lunch with residents on both days of the inspection and therefore was able to spend time in both dining rooms observing the service provided. On both occasions the residents were asked what they wanted to eat from the menu and then they were given their choice. Residents were offered a variety of cold drinks with their meal and staff refilled these as and when required. During one of the meals a resident was given the meal that she had chosen shortly before but said that it was not what she had chosen. The staff explained that it was what she had requested but that it was not a problem and could be changed. The resident was given a different meal and was very happy with this. Two residents required one to one support from staff to eat their meals and this was provided sensitively and kindly. Both residents were given as much time as they needed and were gently encouraged to eat and drink. One of these residents did not eat a lot of the main course but staff said that he liked his desserts so he was given extra, which he ate. Staff displayed a good knowledge of resident’s needs and likes. The cooks are doing NVQ level 2. Overall residents are given meals that meet their needs and preferences. The environment in which they have the meals is very nice and they are given the support that they need at meal times. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 19 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 & 17. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. There is a complaints procedure that is followed in the event of any complaints being made. Staff have received adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This gives residents a greater protection from abuse. EVIDENCE: There is a complaints procedure and this is displayed in the home. Complaints are recorded and dealt with by the manager and the staff team. Residents and relatives are encouraged to voice any problems so that they can be sorted out as soon as possible. The manager said that her door is always open and relatives often pop in to talk to her about things. A record is kept of complaints and this record was inspected. The outcome of the complaints was noted, as was the response to the complainant. In between the two visits the manager had developed some feedback cards for residents to give their opinions on the change of menu. On resident said, “I can talk to anyone and they will sort it out”. Another said, “I don’t have anything to complain about but would say if I did.” It is recommended that a more user-friendly version of the complaints Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 20 procedure be developed to assist residents with dementia to express their dissatisfaction. There is an adult protection policy that tells staff the actions to take in the event of abuse/suspected abuse being discovered. Staff spoken to were aware of the issues of abuse and aware of their responsibility to residents. The home has an open culture and staff, residents and relatives feel able to raise any concerns that they might have. Staff understand what restraint is and the use of any equipment that may be used to restrain individuals such as bed rails and wheelchair belts is decided within a risk assessment framework. Staff have received Protection of Vulnerable Adults training and further training is scheduled for later this year. Residents said “the staff are kind”, “the staff are brilliant”. A relative said, “the staff are kind and patient”. The home does not hold any personal monies for residents. Residents and/or their families are invoiced for services such as hairdressing and chiropody. Residents do have lockable facilities in their rooms so that they can safely store cash or items of value. Shortly after the visit the manager took the necessary action when a resident said something of concern about the way she had been treated. This was reported to the appropriate people and initial information gathered. It would appear that no further action is needed and the manager is waiting for the safeguarding adults team to confirm this. Therefore overall systems are in place to safeguard residents and to take the necessary action should any concerns arise. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 21 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): 21, 22, 23, 24, 25 & 26. People using the service experience excellent quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. Residents live in a safe, well-maintained environment with access to safe and comfortable indoor and outdoor facilities. The home is clean, pleasant and hygienic. Attention is paid to detail throughout the home. The well-maintained building enhances the lives of those living there. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home is in situated in Lodge Lane, close to the Collier Row area of Romford. The bus stops directly outside the home. There are local shops in Collier Row. The home is on 2 floors and is accessible to wheelchair users. There is a lift to the first floor. The communal areas consist of 2 well furnished lounges on the ground floor and one on the first floor. In addition there is a conservatory, which opens onto the gardens. There are two dining rooms both of which have patio doors that lead onto a secure courtyard. There are several bathrooms and toilets throughout the home. Adapted bathing and toilet facilities are available and there are enough baths, showers and toilets to meet the residents’ needs. Until recently there has not been a need for a hoist but as residents are becoming less mobile the home is in the process of purchasing a hoist. Corridors are wide and have handrails to assist residents with mobility problems. The need for the handrails to be extended to cover more of the home was discussed with the manager and she has undertaken to carry this out. Therefore the equipment needed to meet the residents’ needs is available in the home. The home is very well decorated and furnished to a high standard throughout. Some bedrooms were seen by invitation of the residents, whilst others were seen because the doors were open or being cleaned. Residents are encouraged to personalise their bedrooms and all of the bedrooms seen were very personalised and representative of the occupant’s interests, culture and religion. There is a call alarm system fitted to each bedroom, and is located within easy reach of each resident’s bed. All bedrooms are of a good size and 30 rooms have ensuite facilities. One resident said, “this is a lovely place and very clean”. The residents that showed the inspector round said that they were very pleased with their rooms. The kitchen is appropriately equipped and is clean. Food was appropriately labelled and stored. The cook carries out the necessary checks to ensure that the environment meets the necessary standards of hygiene and that residents’ food is prepared in line with good food hygiene practice. There is a separate laundry and this has appropriate equipment. There is a nice garden at the rear of the home and this has a patio area and tables and chairs. There is also a fenced off duck pond. The height of the fence was raised earlier this year to make it safer for residents. Residents spoken to said how nice it was to see the baby ducks wandering around the garden and in the courtyard. On one of the visits some residents were sitting in the garden enjoying the sunshine. At the time of the inspection the home was clean and free from offensive odours. It was evident that standards of cleanliness are high. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 23 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, 28 29 & 30. People using the service experience adequate quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. A staff team that have the necessary skills and training, who know them well and who are committed to providing a good quality service supports residents. Residents are supported and protected by the services recruitment practice. Staffing levels are not sufficient to allow staff time to fully use their skills and experience or to work to best practice. EVIDENCE: At the time of the visit there were 61 residents living at the home. This includes people with dementia who may require additional support to meet their needs appropriately and safely. Staffing levels are 1 team leader and 5 carers on the morning shift and 1 team leader and 4 carers on the late shift. At night there are 3 waking night carers and 1 senior. From examining the rota and discussions with staff it was evident that there are often staff shortages and that even when there is a full shift this is not sufficient. Feedback from staff was that they are concerned about staffing levels and because of this everything is not up to date. E.g. care plans and staff. supervision. Minutes from seniors meetings also referred to residents feeling a Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 24 bit rushed at teatime and also the need for more staff in the mornings to give residents more choice. Feedback from relatives was “staff often seem pushed”, “staff are always very busy”, staff seem a bit pressed”. Domestics, kitchen staff, laundry staff, a handyman and an administrative assistant support the care staff. There are also 2 activity workers. The is a fairly stable staff team but there are not sufficient staff to cover shifts or for there to be sufficient staff on duty. This was discussed with the manager and she acknowledged that she was not happy about the staffing levels but said that she was having difficulty recruiting good calibre staff. She also said that she was committed to finding staff and to providing a good quality service to the residents. Between the two visits the manager had advertised for staff again, had spoken to relief staff about extra shifts and also asked regular staff if they would like to do some extra shifts. As a result of this the intention was to have 8 staff on the morning shift and 6 on the late shift. The manager also said that she would not accept any new residents until she had resolved the recruitment difficulties and had more staff in post. The staffing arrangements at the time of the visits were not sufficient but staff were working very hard to ensure that residents needs were being met. Sufficient staff must be employed to enable sufficient staff on duty to meet residents assessed needs In addition to short courses the staff team have also shown a commitment to achieving their NVQ. Staff either already have NVQ level 2 or 3 or are studying for NVQ. The senior staff have completed NVQ level 3 and the deputy manager has almost completed NVQ level 4. As previously sated staff received Dementia Care training earlier this year when the home became registered to care for people with dementia. Future planned training includes Protection of Vulnerable Adults, end of life care and mental capacity. From discussions with staff and examination of training records it was evident that staff receive thee necessary training to provide an appropriate and safe service to meet the needs of the residents and future training needs have been identified. Staff have job descriptions and in discussion were clear as to their individual role in the home. The service has an appropriate recruitment procedure. There are application forms, and interviews and the appropriate references and checks are made. A random sample of staff records were checked during the inspection and were found to contain the required information. Staff will usually work for a trial shift after they have been interviewed and then do not start work until after they have received their CRB (Criminal Records Bureau) check. The manager was reminded that the staff should have their POVA first check before they do the trial shift and she undertook to ensure that this was always the case in future. She said that they had recently changed the organisation that processed the CRB checks and that this organisation were much better at providing confirmation of POVA checks and that she would be able to have this information on file in future. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 25 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, 32, 33, 35, 36 & 38. People using the service experience good quality outcomes in this area. We have made the judgement using a range of evidence including a visit to this service. The home is very well run and provides a safe environment for the residents. The manager expects good practice from her team, and is keen to provide an excellent service to the residents. However the manager needs to devote more attention to the formal management of the home. This will ensure that paperwork is up to date and that staff receive supervision. Also that issues like the staffing recruitment difficulties are addressed proactively. This in turn will mean that the service provided to residents improves further and that the staff team will be able to fully utilise the skills, experience and good practice that they already have. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home is managed by one of the proprietors. She has 20 years of experience of care services for older people and has managed this home for several years. There has been a repeat Requirement over several inspections that the manager gain an appropriate qualification, and this has not yet been met. In addition to having skills and experience the manager must have the qualifications to manage the home. The manager does however attend all of the relevant short courses to enable her to keep up to date with good practice. The deputy manager has almost completed NVQ level 4 in management and care. The atmosphere in the home is relaxed and friendly. The manager wishes to run a high quality service and staff are aware of the standards that are expected of them. She also promotes equality and diversity issues and is aware of good practice issues. Feedback from a member of staff was “the manager is good to her staff and I find that she listens and is approachable.” Feedback from the contract monitoring officer for the local authority was that this was a good home but they need to improve their paperwork. The manager monitors the quality of the service provided to the residents but there has not been any formal quality assurance. However the manager has devised a quality assurance questionnaire and this is going to be distributed to family and friends and outside agencies with this months invoices. Questionnaires will also be given to residents. The outcome of the quality survey will be monitored as part of the next inspection and the manager was asked to send a copy of the outcome to the Commission. As previously stated the home does not deal with the finances of any residents. Nor does it hold any personal monies for residents. Staff meetings and staff supervision have not been taking place regularly and again this is linked to the staffing situation. Therefore staff have not had the opportunity to discuss problems and to be involved in the development of the service. Additionally they do not have the opportunity to receive feedback or to discuss their work performance and development. Staff must be appropriately supervised and should receive formal supervision at least 6 times per year. With the exception of hot water temperatures all of the necessary health and safety checks are carried out and a safe environment is provided for the residents. This is reflected in the fact that there are very few accidents in the home. Any issues identified are passed on to the handyman to action. The manager said that she thought that as the water temperature was capped to a maximum they no longer needed to check the hot water temperatures. However when this was explained to her she instructed the handyman to start Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 27 carrying out the tests again. Appropriate risk assessments are in place and a fire safety company carried out a fire risk assessment in March 2007. They also carry out staff training. There is a fire procedure but this does not include the action to be taken in the event of a fire at night. This needs to be developed to ensure that staff are clear on the required action in the event of a fire at night when there are less staff on duty and residents will be in bed. Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 28 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 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 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 4 4 4 3 4 4 4 4 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 2 X 3 Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 15 Requirement Residents care plans must be reviewed by care staff at least once per month, updated to reflect changing needs and current objectives for health and personal care, and actioned. The eye drops in use that were stored in the medicines fridge required the date of first opening entered on the container to ensure usage does not exceed the in-use shelf life. Once the eye drops indicated during the inspection are in-use they should be stored at room temperature to improve the administration to residents. The medicines policies & procedures require the inclusion of the requirements for the cold storage of medicines, including the monitoring requirements. Attention is required for the audit of medication to be able to reconcile the records with the quantity available and to account for the blank entries for dose administration on the medicines administration record (MAR) DS0000027862.V337751.R01.S.doc Timescale for action 31/08/07 2. OP9 13(2) 08/06/07 3. OP9 13(2) 08/07/07 4. OP9 13(2) 11/06/07 Lodge (The) Collier Row Version 5.2 Page 30 5. OP9 13(2) 6. OP9 13(2) 7. OP9 13(2) 8. OP9 13(2) charts. For the protection of care staff the home requires a documented policy & procedure and care staff are to be made aware of medicines requiring handling precautions. In view of the difficulty in establishing the audit of a schedule 2 Controlled Drug (CD) (morphine sulphate 10mg. tablets) it is required to keep CD in the CD cupboard available in the home. In accordance with the advice from the Committee on Safety of Medicines, as indicated in the BNF in the section on atypical antipsychotics (4.2.1), the MHRA notification dated 9 March 2004 “New advice issued on risperidone and olanzapine (reference 2004/0095)” and the licensed contraindications. Attention is required to reviewing the prescribing of risperidone for residents diagnosed with a dementia. The pharmacist inspector brought this issue to the attention of the principal GP serving the home during the inspection. When medicines are prescribed with directions for administration on a when required basis or with non-specific directions, e.g. to be taken as directed, documented guidance is to be available with the medicines administration record (MAR) chart to ensure medicines are correctly administered. This includes such guidance as when to administer, frequency, maximum repeated dosing, etc. Details of this requirement are to be included in the medicines policies and procedures. DS0000027862.V337751.R01.S.doc 08/06/07 08/06/07 31/07/07 15/06/07 Lodge (The) Collier Row Version 5.2 Page 31 9. OP9 13(2) 10. OP9 13(2) The entries that staff need to 08/06/07 write on residents’ medicines administration record (MAR) charts, e.g. indicating changes or discontinuation, require their signature or signed initials and the date of the entry together with brief details or reference to another document containing details e.g. district nurse records, for the purposes of accountability. The home’s policy/procedure for 08/06/07 medicines taken out of the home by its residents requires the inclusion of documentation to account for medicines leaving and returned to the home. To facilitate the assessment of 08/06/07 medicine therapy it is required to document the reason for dosage omission on the medicines administration record (MAR) chart when entering the undefined omission code “O”. 08/07/07 To avoid the use of medicines beyond their in-use expiry a policy and procedure is required providing guidance to the home’s staff for the stock control of medicines with a limited in-use shelf life. The good practice of entering the date of first opening should be applied to any medicine where usage may go beyond the in-use shelf life. Sufficient staff must be employed to enable sufficient staff on duty to meet residents assessed needs Staff must be appropriately supervised and should receive formal supervision at least 6 DS0000027862.V337751.R01.S.doc 11. OP9 13(2) 12. OP9 13(2) 13. OP27 18 31/08/07 14. OP36 18 30/09/07 Lodge (The) Collier Row Version 5.2 Page 32 times per year. 15. OP38 23(4) A night time fire procedure must be developed ensure that staff are clear on the required action in the event of a fire at night The Manager must obtain an appropriate qualification. (Previous timescales of 31.12.05 & 31/12/06 not met.) 31/07/07 16. OP31 10 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended that a service user guide in a pictorial format for the benefit of some of those people living with dementia, be developed. To provide clarity of directions for the administration of anticoagulants at the point of medicines use it is recommended to keep the anticoagulant clinical monitoring information (yellow book) with the relevant medicines administration record (MAR) chart It is recommended to review, update and collate the home’s medicines policies & procedures taking into account the information provided in the CSCI Professional Advice documents and that of the Royal Pharmaceutical Society including: • Medicine administration records (MAR) in care homes and domiciliary care. CSCI • The administration of medicines in care homes. CSCI • Training care workers to safely administer medicines in care homes. CSCI • The safe management of controlled drugs in care homes. CSCI DS0000027862.V337751.R01.S.doc Version 5.2 Page 33 2. OP9 3. OP9 Lodge (The) Collier Row • 4.The Administration and Control of Medicines in Care Homes and Children’s Services. The Royal Pharmaceutical Society of Great Britain. 5. OP9 • To provide a useful working document it is recommended that the sections be brought together into a single document with improved indices to provide for ease and speed of reference and to be made available at the point of medicines usage. To avoid the risk of staff acting on outdated information it is recommended to remove the March 1999 edition of the British National Formulary (BNF) leaving the more recent September 2005 edition available for reference It is recommended that the home’s policy & procedure for dealing with errors in the administration of medicines includes reference to the action to be taken when staff are unable to immediately contact a resident’s GP. Details for contacting NHS Direct would be helpful in this situation to avoid any unnecessary delay in obtaining a health professional’s advice. It is recommended that the use of lactulose on a when required basis to relieve the constipation of residents (SU) be reviewed by their GP. The mode of action of this laxative normally requires 2 to 3 days for therapeutic effect and is therefore unsuitable for intermittent use. Prescribing for constipation should be reviewed and if a laxative is still required on a when required basis, either with or without regular administration of lactulose according to individual resident requirements, then a stimulant or mixed action laxative may provide more effective therapy, e.g. magnesium hydroxide mixture or senna. The pharmacist inspector brought this issue to the attention of the principal GP serving the home during the inspection. BNF section 1.6.4 refer It is recommended that a more user-friendly version of the complaints procedure be developed to assist residents with dementia to express their dissatisfaction. 6. OP9 7. OP9 8. OP16 Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Lodge (The) Collier Row DS0000027862.V337751.R01.S.doc Version 5.2 Page 35 - 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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