CARE HOMES FOR OLDER PEOPLE
Lodore Nursing Home Lodore Nursing Home 9 Mayfield Road Sutton Surrey SM2 5DY Lead Inspector
Alison Ford Unannounced Inspection 25th October 2005 14:15 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 Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Lodore Nursing Home Address Lodore Nursing Home 9 Mayfield Road Sutton Surrey SM2 5DY 020 8642 3088 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 Stephen Pittman Ms Kalsum Mohd Noh Care Home 36 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0), of places Terminally ill (0), Terminally ill over 65 years of age (0) Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. A maximum of ten service users in the DE(E) category. A maximum of eight service users in the TI and TI(E) categories aged 40 or over 4th May 2005 Date of last inspection Brief Description of the Service: Lodore is a home registered with The Commission for Social Care Inspection tp provide nursing care for up to 36 older people. Up to eight of these beds may also be used for younger service users requiring palliative care. The home has forged strong links with the local hospice to devlop a level of expertise in this field and is part of a new community based programme The Gold Standard Framework. The home is situated in a pleasant tree-lined road in Sutton within walking distance of the town centre. It is an edwardian building which has been tastefully extended to provide accomodation over three floors. There has been an extensive programme of redecoration and refurbishment and this has been completed to a very high standard. All but two of the rooms are accessible by means of a passenger lift and a stair lift is provided for those two. There are eighteen single and nine double rooms. There are newly appointed bathrooms on each floor and a variety of aids and adaptations have been provided. The home is staffed twenty-four hours a day by a mix of trained nurses and care staff and the registered manager of the home is also a trained nurse. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes second inspection of 2005/2006 and was an unannounced visit starting at 14.20 pm and lasting for two and a half hours. During this time a partial tour of the premises was undertaken, a sample of care planes were assessed, and several residents and three relatives, who were visiting at the time, were spoken to. Prior to the inspection comment cards had been received from thirteen residents, four of their relatives and four GP’s who regularly visit the home. All of these reflected a very positive opinion of the home and the services that are provided. The manager was not on duty at this inspection however the senior nurse was welcoming and knowledgeable. All of the requirements resulting from the last inspection have been complied with and there have been no complaints about the service either directly to the home or to the Commission For Social Care Inspection. During the inspection year, all of those standards that are considered by The Commission, to be key to the inspection process have been assessed. This report should be read in conjunction with the one following the inspection of 4th may 2005. What the service does well:
This home is always presented to a very high standard while retaining a friendly, warm and welcoming atmosphere. All areas were clean and free from odour on the day of the inspection. All of the residents appeared well cared for and happy. Those who were able to communicate expressed their satisfaction with the home and the staff and commented that “they felt well looked after “ and “the staff were very good”. One said “that he had no worries anymore and would recommend it to anyone”. Various activities were favourably received and all the residents enjoy the things that are arranged for them. Complimentary letters were also seen which supported theses comments. The food served in the home and the choices offered were praised and menus seen were varied and nutritious. Only one adverse comment was received and that was about there being too much food to eat, although the resident did appreciate the amount of tea that was served . Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 6 Many of the staff have been in post for some while and there is a positive commitment to staff training and development. The home is participating in a community programme to care for people in the last stages of their lives `The Gold Standard Framework, which promotes best quality care. 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. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 A comprehensive pre-admission assessment ensures that the healthcare needs of potential residents can be met. EVIDENCE: The care plans of two residents who were being cared for according to The Gold Standard Framework were seen. These showed that a comprehensive assessment process had been undertaken to ensure that the home would be able to meet their needs. This then formed the basis of subsequent care planning. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents in this home are treated with dignity and respect. Their health needs are identified and reviewed regularly so that they continue to be met and they are protected by the homes medication procedures. EVIDENCE: Care plans were seen of two residents. They had been generated from the initial assessment process and showed evidence of regular review, to ensure that they reflected the care currently being given, and input from other healthcare professionals as needed. There was evidence that consideration is given to identifying those at risk from developing pressure sores and appropriate interventions are in place. Residents were observed being treated in a respectful manner and all personal care is delivered in private. Staff were seen to knock on doors and call out before entering. Those residents who were in shared rooms were happy to do so, and adequate screening is provided. Medication procedures were seen to be in order and a recent pharmacy audit had not raised any concerns. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection. EVIDENCE: Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection. There have been no complaints made either to the home or to The Commission since the last visit. EVIDENCE: Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 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 This home continues to provide a well-maintained, clean, safe and comfortable environment, which meets resident’s needs. EVIDENCE: A partial tour of the premises was undertaken. The home is an attractive property, which has been refurbished to a high standard and is well maintained. Adaptations have been provided throughout, to aid those with reduced mobility. There is rear garden, which is accessible to all the residents and is much enjoyed in the summer months. A tour of the premises included a sample of resident’s bedrooms, which are comfortable and tastefully decorated. There are appropriate door locks and lockable facilities have been provided. Radiators have been guarded. On the day of the inspection the home was clean and free from odour.
Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 13 To help to ensure residents safety in the event of a fire, and comply with current legislation, automatic door closers have now been fitted to bedroom doors Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 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): 27,29 Residents in this home are cared for by well-trained and competent staff who are able to meet their assessed needs. Evidence that recruitment policies are sufficient to protect residents is not always available. EVIDENCE: On the afternoon of the inspection there were two trained nurses on duty with four care staff. This was in line with previously agreed level. The off duty rotas were seen and reflected that this was the always the case. The home places an emphasis on staff training much of which relates to palliative care needs of residents and there are strong links with the local hospice. All mandatory training has been undertaken and regular staff meetings occur, the minutes of which were seen. Staff files were not available for inspection as the manager was not on duty and the pre-inspection questionnaire did not provide evidence that all staff had received Criminal Records Bureau, or Protection of Vulnerable Adults register clearance, prior to commencing their employment. A further visit was made on 02/11/05 to establish that all pre-employment policies and procedures were in place. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 15 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): 38 Evidence was not available to show that maintenance programmes are in place to minimize risks to resident’s safety. EVIDENCE: The previous inspection had shown that several maintenance certificates were about to expire. As the homes manager was not on duty, these were not available to be checked at this visit and the pre-inspection questionnaire did not provide evidence that they had all been carried out. A second visit was undertaken on 02/11/05 at which all the dates on which these checks had been undertaken were made available. In future it is recommended these dates should be detailed on the preinspection questionnaire as requested by the Commission. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A 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 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X 3 Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 17 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. Standard Regulation Requirement Timescale for action 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 29,38 Good Practice Recommendations It is recommended that, in future, all information requested on the pre-inspection questionnaire should be submitted prior to the inspection visit. Lodore Nursing Home DS0000019104.V256069.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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