CARE HOMES FOR OLDER PEOPLE
Lodge The Residential Care Home Heslington York YO10 5DX Lead Inspector
Mrs Maggie Coxon Unannounced Inspection 7th February 2006 10:00 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 Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Lodge The Residential Care Home Address Heslington York YO10 5DX 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) 01904 411087 01904 411087 Colourscape Investments Limited T/A The Lodge Residential Home Mrs Geraldine Ann Timbs Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th August 2005 Brief Description of the Service: The Lodge is a care home registered by Colourscape Investment Limited to provide accommodation and personal care to up to twenty-four older people who may have dementia. The company has recently been sold and new directors have been appointed. 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 accommodation. None of these rooms has en suite facilities; there are however sufficient bathroom and WC facilities for the residents that 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 hard standing for parking to one side of the building. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was the second to be undertaken between April 2005 and March 2006. It was done on 7th January 2005, at a time when all of the people living in the home would be present. It took 4.5 hours plus 1 hour’s preparation time. Any key standards not assessed during this inspection have been assessed at the last inspection and reported on in the subsequently published report. 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 one of the new company directors, with the registered manager and deputy manager as well as with care and ancillary staff. A number of records and various areas of the home, including bedrooms and shared areas, were seen. What the service does well:
The registered person, registered manager and staff team are committed to putting the needs and wishes of the residents first. Residents are encouraged to be as independent as possible and there is always someone on duty at any given time to ensure that residents are given individual attention where required. Residents said that staff and management are kind and helpful and they praised the quality of the meals provided. Staff communicate well with residents who are encouraged to make choices and decisions about their daily lives wherever possible. Good assessment and care planning systems are in place, which help the registered manager to decide if and how the staff team can meet the health and social care needs of prospective residents. These systems also help the team to understand and meet the needs and wishes of people currently living in the home including any changes to these. The home is well maintained and was clean, warm and comfortable at the time of this inspection. Residents said that they like their bedrooms and have included their own belongings including in some cases their own furniture. Good systems are in operation, which are supported by well-maintained records. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 6 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. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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): 1. Prospective residents and/or others involved in arranging a placement within the home can 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 and accurate. EVIDENCE: The previous directors of Colourscape had produced a statement of purposecum-service user guide that 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 been identified however that this document needed further development. Since the change of directorship within the company, some of the information contained is now also factually incorrect. The new director who was present at the inspection agreed to develop both a new statement of purpose and a service user guide. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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): 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. Staff liaise very well with health care professionals. 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 staff team has recently undertaken appropriate medication training through a local college. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 the following standard(s): 13 and 15. Residents maintain good relationships with family and friends. They also enjoy a wide choice of home cooked, good quality food. EVIDENCE: 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. They said that staff are always friendly and helpful and keep them well informed of anything affecting their relative. Residents are encouraged to eat a healthy diet. The catering staff are currently unable to use some of the kitchen equipment because the ventilation system requires upgrading. The new director explained that this work is due to start within the next few days. In the meantime staff have been provided with alternative equipment and the cook was seen to prepare a well-cooked, nutritious lunch for the residents a number of who said that the meals provided are very good. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 the following standard(s): 16. 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. The new director said that she plans to introduce a comment book as part of the home’s future quality assurance system. One complaint has been made to the C.S.C.I. since the last inspection. This concerned staff smoking in the dining room and an occasional lapse in the promotion of personal hygiene for residents. It was found that the first concern was now unsubstantiated as since the change in ownership of the home, staff do not smoke in the dining room, they are now only allowed to smoke in the staff room or outside of the building. The registered manager explained that only two of the residents smoke and they also now usually smoke in the staff room. She said that on the odd occasion when a resident does smoke in the dining room, the window is opened and the serving hatch to the kitchen is closed. The second concern was also found to be unsubstantiated. The registered manager explained that residents are always encouraged to maintain a high level of personal hygiene and agreed that in future, staff would record any exception to this, which only occurs at the express request of the resident concerned.
Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 the following standard(s): 19,20,21,24,25 and 26. The standard of the environment is good and provides residents with a safe, clean and generally comfortable place in which to live. EVIDENCE: The home is well maintained, 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. Residents spoken to say that they are very happy with their rooms. 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.
Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 13 The dining area has been improved because staff no longer smoke in this area. The new director said that she plans to have new carpets laid in the ground floor communal areas. These will be more suitable for people with dementia than are the present carpets, which are multi patterned. A new carpet has been laid on the main staircase and first floor landing since the last inspection and a new deep freeze has been bought. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. The residents receive a good standard of care from a skilled and experienced staff team. The safety and wellbeing of residents could potentially be compromised however by a shortfall in the recruitment procedure and in staffing levels. EVIDENCE: At the last inspection, personnel records were not available for inspection because only the registered manager, who had not been present, had access to these records. These records were available on this occasion as she was present. Appropriate recruitment procedures are, in the main, being followed thereby safeguarding the wellbeing of residents. These procedures include the carrying out of all required checks on new staff. The only exception to this was that the CRB certificates for two of the carers had been obtained from previous employers. Whilst CRB certificates had formerly been portable, subsequent guidance from the Criminal Records Bureau dictates that any new employer must now undertake a fresh enhanced check. The registered manager had been unaware of this change in policy. A recommendation made in previous reports was that induction training provided to newly appointed care staff must be to an appropriate standard. The registered manager said that she is investigating appropriate training. Three of the twenty-five care staff have completed their NVQs in care. The director and registered manager are aware that the home is quite some way
Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 15 from achieving the target of having 50 of care staff trained to NVQ level 2 or above but expressed a commitment to improvement in this area. The current duty roster shows that staff are not employed in sufficient numbers to ensure that the needs of the residents are met at all times. This is based on the number of hours required by the national minimum standards which state that a minimum of 556 hours are needed per week between the hours of 07:00 hrs and 22:00 hrs for 24 residents with dementia. The number of hours being worked this week are 71 hours short of that minimum number. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 37. 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. It is evident that she runs the home in the best interests of the residents at all times. It was previously identified that whilst the registered manager gives staff regular appraisal and supervision, she has not undertaken training in these areas. This situation remains the same but the new director agreed to consider arranging appropriate training for all staff undertaking this role. It was also previously identified that, whilst the quality of services provided in the home was assessed in an informal way with residents’ views and opinions being listened to and acted upon by the registered manager, the quality
Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 17 assurance system should be further developed and an annual plan be produced from the outcomes of this. The new director agreed to adopt and develop a suitable system. Procedures and records are well maintained and since the last inspection a facsimile machine has been installed in the home. The availability of this equipment should improve on and enhance the current means of communication between the home and professional colleagues and agencies including the Commission for Social Care Inspection. Up to present the home has not handled personal monies on behalf of residents. The new director explained however that a system of providing this service is to be put in place. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 3 X X 3 3 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 3 X Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 Page 19 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 OP27 Regulation 18 Requirement Timescale for action 07/02/06 2. OP29 19 The registered person must ensure that staff are employed in sufficient numbers and for sufficient hours to meet the needs of the residents at all times. A CRB and POVA check must be 01/04/06 undertaken by the organization for the two staff who have not been checked by them since the individuals’ most recent employment at the home. 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 More detailed and current information should be included in the home’s statement of purpose and a service user guide should be produced. Copies of both documents should be submitted to the CSCI on completion. A minimum of 50 of care staff should be qualified to NVQ level 2 or above.
DS0000038016.V280173.R01.S.doc Version 5.1 Page 20 2. OP28 Lodge The Residential Care Home 3. 4. 5. OP30 OP31 OP33 6. OP36 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 on quality issues of residents, staff, relatives and health care professionals should be sought and incorporated into a robust quality assurance and monitoring system. An annual plan for the home should then be drawn up. Any staff providing appraisal and formal supervision to other staff should be given appropriate training. Lodge The Residential Care Home DS0000038016.V280173.R01.S.doc Version 5.1 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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