CARE HOMES FOR OLDER PEOPLE
The Lodge Residential Care Home Heslington York North Yorkshire YO10 5DX Lead Inspector
Maggie Coxon Unannounced 17 August 2005
th 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 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. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Lodge Residential Care Home Address Heslington York North Yorkshire YO10 5DX 01904 411087 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Colourscape Investments Limited Mrs Geraldine Timbs Private Care Home 24 Category(ies) of Old Age. Dementia over 65 registration, with number of places The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 17/03/05. Brief Description of the Service: The Lodge is a care home registered by Colourscapes Investment Limited to provide accommodation and personal care to up to twenty four older people who may have dementia. The Responsible Individual is Mr Dennis Raymond Higgins. The home consists of a large, detached, pre-Victorian house with a newer purpose built extension. It is situated in the village of Heslington and is within walking distance of local facilities and amenities including shops, cafes and pubs. The amenities of York city centre are also accessible by transport. Twenty of the twenty two rooms are for single accommodation, two are for shared accomodation. None of these rooms has ensuite facilities, there are however sufficient bathroom and WC facilities for the residents which are located close to bedrooms as well as ground floor shared rooms including the dining room,lounge and quiet room. Bedrooms are situated on the ground and first floors, the latter being accessed by one of two staircases. The home does not have a passenger lift but one of the staircases has a stair lift. There is ramped access to the home. The home has a large well maintained garden and there is an area of hardstanding for parking to one side of the building.
The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the first to be undertaken between April 2005 and March 2006. It was done on 17th August 2005, at a time when all of the people living in the home would be present. It took 6 hours plus 1 hour’s preparation time. Discussions were held with a number of people currently living in the home, and with the relatives of one resident who was visiting at the time. Discussions were also held with the deputy manager, the registered person and with care staff. A number of records and various areas of the home, including bedrooms and shared areas, were seen. What the service does well: What has improved since the last inspection? The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 6 A number of improvements have been made since the last inspection. These include: One of the bedrooms has been redecorated and a new carpet has been ordered for the main staircase and first floor landing. The knowledge and understanding of the staff team has increased through members having undertaken more training. Staff have been allocated some time off rota to study. The servicing of equipment has improved, increasing the level of safety to residents. 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 Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 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 standard(s) 1,3 and 6. Prospective residents and/or others involved in arranging a placement within the home are assisted to make an informed choice thanks to the provision of some information about the home and services provided. This process would be further assisted however, if the information provided were more detailed. EVIDENCE: A statement of purpose-cum-service user guide has been produced. This provides some information concerning services and facilities provided within the home to prospective and current residents and anyone else involved in arranging a placement within the home. It had previously been identified however that this document needs further development, the deputy manager had no knowledge however of this having been done. An assessment of the needs of each resident has been undertaken prior to their admission and a well-structured introductory programme is followed. The home does not provide intermediate care. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10. Residents’ personal and health care needs are fully met. EVIDENCE: All of the people living in the home are registered with a local GP through whom specialist health services are accessed as and when needed. Each of the residents has health checks as required and residents said that they are confident that their health needs are being fully met. Members of the staff team were seen to communicate well with residents and to support them with their personal care needs in a way that respected the individual’s dignity. None of the residents is able to take their own medication. There is a good medication procedure in operation and all medication is securely stored. Medication administration records are well maintained and the deputy manager explained that the staff team is currently undertaking appropriate medication training. It was seen that care staff have been allocated time off rota to complete this training. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 10 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 standard(s) 12,13 and 15. Residents make as many choices as they are able to with help from the management and staff team and develop and maintain good relationships with family and friends. They enjoy a wide choice of home cooked, good quality food and some activities and entertainment arranged by the home throughout the year. EVIDENCE: The registered providers clearly state in the statement of purpose-cum-service user guide that they “believe it is the responsibility of family and friends to provide the mental stimulus in the life of the resident”. They also state that organized trips outside of the home are not provided. Entertainers however are periodically brought into the home and a clothes sale is held annually. Staff were seen to accompany residents on short walks and a church service was also provided in the home during the inspection, this occurs monthly. Residents are supported to develop and maintain relationships with families and friends. The relative of one of the residents explained that they are free to visit the home at any time. Residents are encouraged to eat a healthy diet. They said that the meals provided are very good and the cook was seen to prepare a well-cooked, nutritious lunch for them.
The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 16 and 18. Residents’ concerns are appropriately dealt with and their interests are safeguarded. EVIDENCE: There is a comprehensive complaints procedure in operation that is made available to anyone who wishes to see it. No complaints have been made to the home or to the C.S.C.I. since the last inspection. The staff team has developed good relationships with the residents and were seen to communicate well with them. One of the residents said that they would be happy to discuss any concerns they might have with the registered manager. Staff are aware of the adult protection procedure in place and explained that they know what they should do should any incident be witnessed or an allegation be made. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 19,20,20,21,23,24,25 and 26. The standard of the environment is good and provides residents with a safe, clean and generally comfortable place in which to live. The comfort of some people could be improved however by the implementation of alternative smoking arrangements. EVIDENCE: The home is well maintained and pleasantly decorated and furnished throughout and a good standard of cleanliness is maintained. Twenty bedrooms are for single accommodation; two are double rooms. They are all of a suitable size and are pleasantly decorated and furnished. These are situated on ground and first floors in the original building and also in the single storey annexe. First floor rooms are accessed by two staircases, one of which has a stair lift; the home does not have a full passenger lift. One bedroom has been redecorated since the last inspection having recently become vacant. Each of the residents spoken to said that they are very happy with their rooms. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 13 Whilst none of the bedrooms has en suite facilities, they are all close to shared bathrooms and there are WC facilities that are easily accessible from the shared areas on the ground floor which include a kitchen, a dining room, a main lounge and a quiet lounge. All these areas are well maintained and furnished and are pleasantly decorated. The smoking area for residents and for staff if they so choose, is at a designated table in the dining room. Previous recommendations that an alternative location be designated for residents and that staff be permitted to smoke in the staff room only have not, to date, been implemented. A new carpet has been ordered for the main staircase and first floor landing. There are some aids in place within the home and there is ramped access to one door. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30. The residents receive a good standard of care from a skilled and motivated staff team. Continual accessibility to personnel records could be improved thereby improving the safety of residents. EVIDENCE: Personnel records were not available for inspection because only the registered manager, who was not present at the inspection, has access to these records. In response to a statutory requirement made in the last inspection report, the registered person gave assurance that appropriate security checks including CRB checks have now been undertaken on all staff including those most recently employed. It was not possible to verify this however because no one including the registered person could access this information. Arrangements should be made whereby the individual, who is designated as responsible for the home at any given time, has access to all information held in the home. A recommendation was made in the last report that action should be taken to make sure that induction training provided to newly appointed care staff is of an appropriate standard. The deputy manager did not know if this had been done. Several of the care staff have completed their NVQs in care and others are working hard towards achieving theirs. Some progress has been made in this area and it is hoped that the target of having 50 of care staff trained to NVQ level 2 or above by 2005 will be achieved.
The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 15 Staff are currently undertaking First Aid refresher training and fire training from an external provider has been arranged. The deputy manager explained that the home is currently fully staffed. The current duty roster shows that staff are employed in sufficient numbers and are deployed in such a way as to ensure that the needs of the residents are met at all times. Care staff on duty said that they think current staffing levels are good and as previously mentioned, they have allowed for staff to have some time of rota to undertake their medication training. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36, 37 and 38. The residents benefit from a well managed home in which their needs and wishes are put first. EVIDENCE: The registered manager has considerable management experience and is currently undertaking an appropriate management qualification. Residents and staff said that she is very approachable and is very supportive and encourages the residents’ personal development. It is evident that she runs the home in the best interests of the residents at all times. Staff said that she gives them regular supervision. The deputy manager did not know whether the registered manager has yet undertaken supervision training, as was recommended in the last inspection report. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 17 The registered person and registered manager currently assess the quality of services provided in the home in an informal way. Residents explained that their views and opinions are always listened to and that they are confident that the registered manager would try to make any improvements that they might suggest. A recommendation was previously made that the quality assurance system be further developed and that an annual plan be produced from the outcomes of this. The deputy manager did not know if this has yet been done. There are appropriate policies and procedures in place for staff to follow thereby promoting the well being of residents and records are maintained to a good standard. The home does not however have a facsimile machine. The availability of this equipment could improve on and enhance the current means of communication between the home and professional colleagues and agencies including the Commission for Social Care Inspection. Regular health and safety checks of the home and systems in operation are undertaken and no health and safety concerns were raised at this inspection. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 2 3 x 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 3 2 x x 2 2 3 The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 19 No. Are there any outstanding requirements from the last inspection? 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 29 Regulation 19 Requirement All records maintained by the home must be accessible for inspection at all times. Timescale for action From 26th September 2005 to be maintained thereafter. 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. 2. 3. 4. 5. 6. Refer to Standard 1 20 28 30 31 33 Good Practice Recommendations More detailed information should be included in the homes statement of purpose-cum- service user guide. Consideration should be given to changing the location of the smoking area within the home for service users and confining the smoking area for staff to the staff room. A minimum of 50 of care staff should be qualified to NVQ level 2 or above. Induction and foundation training should meet the standard set by the Skills for living organization. The registered manager should complete an appropriate management qualification. The views of all people involved in the home, in respect of the quality of services provided, should be sought and incorporated into the quality assurance system in operation. An annual plan for the home should then be drawn up.
J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 20 The Lodge Residential Care Home 7. 8. 36 37 Any staff providing appraisal and formal supervision to other staff should be given appropriate training. A facsimile machine for business use should be provided in the home. The Lodge Residential Care Home J53 J04 S38016 The Lodge V242793 170805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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