Inspection on 01/08/06 for Loxley Chase

This inspection was carried out on 1st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Loxley Chase 25/07/07

Loxley Chase 10/01/06

Loxley Chase 19/07/05

Loxley Chase 19/01/05

Loxley Chase 14/07/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Loxley Chase 3a & 5 The Crescent Linthorpe Middlesbrough TS5 6SD Lead Inspector Julia Connor Key Unannounced Inspection 1st August 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Loxley Chase DS0000039334.V305929.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. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Loxley Chase Address 3a & 5 The Crescent Linthorpe Middlesbrough TS5 6SD 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) 01642 818921 Mr George Dixon Mrs Susan Olive Ellis, Mrs Angela Catherine Allick, Mr Michael Dixon Mrs Michelle Morrell Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th January 2006 Brief Description of the Service: Loxley Chase is a care home providing personal care for older people. It is a two-storey building providing both single and shared accommodation for 19 Residents. There are 13 single bedrooms and 3 double bedrooms one of which is currently being used as a single bedroom. The single bedrooms are a minimum of 10 sq.m and the double bedrooms are a minimum of 16 sq.m. There is a stair lift giving access to the upper floor. There is a lounge and dining room on the ground floor and a lounge/dining room on the first floor. There is also a small sitting area, known as the Library, that over looks the front of the house and a small area for those Residents who smoke. Loxley Chase is situated close to local shops and amenities; a bus service provides access to Middlesbrough town centre. There is car parking at the rear of the home. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out by one Inspector and took a total of seven hours. Four Residents’, one visitor and two members of staff were spoken to during the inspection. The current fees structure is £338.00 a week. What the service does well: What has improved since the last inspection? A sluicing facility has been purchased for the laundry equipment. The smoking room, one hallway and four bedrooms’ had been decorated. Three bedrooms’ have had a new carpet; one bed has a new headboard and two bedrooms have had new curtains. One new bed has been purchased. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 6 The upstairs dining room has new dining chairs and the conservatory has had new blinds for the windows. 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. Loxley Chase DS0000039334.V305929.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 Loxley Chase DS0000039334.V305929.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ are assessed prior to being admitted to the home. EVIDENCE: There was evidence in the care files that the home received information from the Social Worker or discharging ward regarding the Resident prior to them being admitted to the home. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 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 and 10 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The Residents’ health, personal and social needs are recorded in an individual plan of care however more information is required when recording how a Resident has spent his/her day. Medication is dispensed appropriately and Residents’ are protected by the home’s policies and procedures for dealing with medication. The Residents’ health care needs are met and Residents are treated with respect and dignity. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 10 EVIDENCE: Two sets of care documents were audited and contained care plans and risk assessments, which had been evaluated within the specified time. However, the daily record gave insufficient information for example ‘fine no apparent problems’ does not give an accurate record of how the Residents’ spend their day. There was evidence that Residents’ or their representative had had access to their files and agreed the plans of care. Doctors, District Nurses, Chiropodists etc are requested to visit the Resident as and when necessary. There is a policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. The Residents’ who spoke to the Inspector felt the staff treated them with respect and dignity. One Resident stated that he liked his privacy and that the staff always respected this. This Resident had also signed to confirm that he agreed with his care plans. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Activities take place within the home on a regular basis and Residents’ receive a wholesome and appealing diet. Residents’ maintain contact with family and friends and are encouraged to make choices in their every day lives. EVIDENCE: There is an activities organiser in post who currently works one day a week. The Manager informed the Inspector that she hoped to increase this to two days a week. The home has a ‘tuck shop’, which the Residents’ enjoy. One Resident informed the Inspector that she attended her art classes twice a week and her pottery class once a week, which she really enjoyed. This Resident also enjoyed the visiting library, and informed the Inspector she had been a Liberian herself. This Resident had a fax machine in her bedroom so her son and daughter, who lived abroad, could keep in contact with her. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 12 Another Resident stated that he did not join in activities, as he preferred to stay in his bedroom and read or watch TV. This Resident stated that he enjoyed going for a walk to the shops and if he did not wish to go the girls did his shopping for him. A third Resident informed the Inspector that she joined in the activities when she wished, but she predominantly preferred to stay in her bedroom and read. This Resident had a telephone in her bedroom so she could keep in touch with family and friends’. There is a four-week menu plan but an alternative to the menu is always available. One Resident informed the Inspector that he often bought his own individual meals and the cook was always happy to prepare them for him. This Resident stated that he was on a special diet but it was not a problem to the staff. Another Resident stated that the food was OK and there was always something different if you didn’t like what was on the menu. A third Resident stated that she was ‘picky’ with her food but the staff made sure that she always had something nice to eat. On the day of the inspection there were sufficient staff to give assistance to those Residents’ who required it. A visitor to the home stated that her relative received ‘ a good quality of care’. She stated that she was always made welcome and that the staff always made time to have a laugh and a joke. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ and their family members’ are confident that their complaints will be listened to seriously and action taken. There are polices and procedures in place to follow should abuse be reported. EVIDENCE: There is a complaints policy and procedure in place, which outlines the stages the complainant should take to make a formal or informal complaint. Complaints are recorded appropriately and are available for inspection. The visitor who spoke to the Inspector stated that what she found helpful was that the ‘staff listen to you’. Policies and procedures are in place in relation to adult protection and prevention of abuse. The home has a copy of the Teeswide No Secrets Protection of Vulnerable Adults Guidance. Refresher training regarding the protection of vulnerable adults has been planned for September and October this. The staff that spoke with the Inspector were aware of the action to take should they witness any form of abuse. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 14 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, 23 and 26 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ live in a well-maintained environment, and their bedrooms meet their needs. Residents’ have access to safe and comfortable outdoor communal facilities and on the day of the inspection the home was clean, pleasant and hygienic. EVIDENCE: The smoking room, one hallway and four bedrooms’ had been decorated. Three bedrooms’ have had a new carpet; one bed has a new headboard and two bedrooms have had new curtains. One new bed has been purchased. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 15 The upstairs dining room has new dining chairs and the conservatory has had new blinds for the windows. There is still no sluice but the work to extend the home has not commenced. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The duty rota indicated the appropriate number of staff where present in the home on the day of the inspection. Staff are being trained to NVQ Level 2 which should ensure that they can meet the Residents’ needs. The Residents’ are protected by the home’s recruitment practices and staff receive training to enable them to care for the Residents’. EVIDENCE: An audit of the duty rota showed that there was one senior care assistant and two care assistants’ on duty from 8.00 am to 10.00 pm and two care assistants’ on duty on a night shift. The Manager recorded in the pre-inspection questionnaire that 60 of the care staff had an NVQ Level 2 or 3 in care. An audit of three personnel files showed that the home complied with the requirements stipulated in Schedule 2 of the Care Home Regulations 2001. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 17 Three training files were audited and showed that training had taken place for example Fire, The Needs of the Resident, Challenging Behaviour and Manual Handling. Staff who spoke to the Inspector confirmed that training takes place. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The registered Manager has many years experience of working in the care home setting. There was evidence that quality assurance and quality monitoring takes place. The Residents’ personal finances are safeguarded and polices and procedures are in place. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 19 EVIDENCE: The Residents’, staff and visitor spoke well of the Manager. The visitor stated that the Manager was very good and listened to what was said to her. The Residents’ stated that the Manager was always available to them. There is a quality assurance and quality monitoring system in place within the home. Regulation 26 visits are forwarded to the Commission for Social Care Inspection on a monthly basis. A record is kept of all the money a Resident receives and spends and receipts are obtained and kept in an individual wallet. There are two signatures when money is deposited or withdrawn. There is a policy and procedure in place for Residents’ finances. The home has Health and Safety Policies and Procedures in place. The Manager recorded in the Pre-inspection questionnaire that equipment was maintained as required, for example the fire equipment was serviced in March 2006 and the emergency lighting was checked in December 2005. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 3 3 X X 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 21 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 OP26OP26 Regulation 23 Requirement The registered person must install a sluice facility in the home. THIS REQUIREMENT IS OUTSTANDING FROM THE JANUARY 2005 INSPECTION. Timescale for action 31/12/06 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. Refer to Standard OP7OP7 OP31OP31 Good Practice Recommendations More information is required when recording how a Resident has spent his/her day. The Manager should pursue the completion of obtain her NVQ Level 4 in management. Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Loxley Chase DS0000039334.V305929.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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