CARE HOMES FOR OLDER PEOPLE
Loxley Chase 3a & 5 The Crescent Linthorpe Middlesbrough TS5 6SD Lead Inspector
Joanna D White Unannounced Inspection 10th January 2006 10:45 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.V258799.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. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 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.V258799.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 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.V258799.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection commenced at 10 45 a.m. and concluded at 3.15 pm. Seven residents, two visitors, and two members of staff were spoken to during the inspection. What the service does well:
One resident informed the inspector she was looking forward to her birthday and a cake was being provided. She said she was well looked after and added the staff were very kind to her. Another resident who spoke to the Inspector said she was encouraged by the staff to attend pottery classes in Middlesbrough, which she enjoyed. She had a fax machine in her room, which helped her to keep contact with her family. A further resident said he had not been living in the home very long and was beginning to feel more settled. He said he was able to visit the local shops as long as the staff knew where he was and when he returned to the home because they worried about him. A resident said she had been poorly and unable to attend the local Catholic Church. However someone from the church had visited her every Friday and now she was feeling much better she was hoping to return to attending the church each Sunday. She said the staff had looked after her very well during her period of illness. Another resident who spoke to the Inspector said she was able to go in a taxi each week and visit an osteopath. She said she experienced a lot of pain but that this was relieved by the care she received and managed by the pain relief she was given by staff. A resident spoke to the inspector and said she was very well looked after. She had been living in the home for a number of years and had no complaints. She said her specific needs were met by the care she received and the food she was given. Another resident spoke to the inspector and said he was encouraged to read books. He also confirmed he took part in the local fete each year having particular responsibility for the bookstall.
Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 6 The Inspector spoke to two relatives. They said they had chosen this home for their relative because the staff had been very welcoming and had a homely feel and they felt able to raise any issues with the staff if this was necessary. They added their relative had been very ill and the exceptional care, in their opinion, provided by the care staff aided her recovery. They added their relative was always clean and well dressed. 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. Loxley Chase DS0000039334.V258799.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 Loxley Chase DS0000039334.V258799.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 Information is made available for Prospective residents to make an informed choice about where to live. EVIDENCE: The statement of purpose and service users guide was audited. They were both written in clear English and produced in large print, which was suitable for intended residents. A copy of the most recent inspection report was available. In addition there was information available on the homes notice board about the vision, values, leadership, commitment and responsibility of the home. There was also a copy of a Charter of Residents Rights and advocacy and a leaflet explaining the No Secrets Policy and Procedures for the Teeswide Area including a Quality Assurance Survey for Visitors. Loxley Chase DS0000039334.V258799.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): 89 The residents’ health needs are fully met. Policies and procedures were in place for the receipt, recording, storage, handling, administration and disposal of medicines. EVIDENCE: The Policy and Procedures for the receipt recording storage handling administration and disposal of medicines were audited. The manager who spoke to the Inspector said one service user was able to take responsibility for his or her own medication. The inspector audited the risk management framework for this resident. Staff on the day of the inspection said designated and appropriately trained staff administered all of the medicines including the controlled drugs. One resident during the inspection was visited by the District Nurse and another by the GP. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 10 Two residents files were audited and contained records of District Nurse Visits, GP visits, hospital, medical, chiropody and dental appointments. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 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 15 The life style experienced by the residents within the home meets their expectations, and preferences, and social, cultural, religious, recreational interests and needs. The Home promotes residents contact with family friends representatives and the local community. The Residents are able to control their own lives and make informed choices about what they do and the services they receive. The residents receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. EVIDENCE: One resident who spoke to the inspector said during a recent illness she had been visited on a regular basis by a member of the local Catholic Church. She said now she was feeling better and was looking forward to attending the Church each Sunday. Another resident said she was encouraged by the staff in the home to attend a local pottery class in Middlesbrough.
Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 12 Two relatives who spoke to the inspector confirmed they and their family visited the home on a daily basis and they always felt welcome and encouraged to see their relative as often as possible. One resident confirmed he visited Middlesbrough but he had to inform staff when he left the building and when he returned. The manager who spoke to the inspectors said a company activity organiser was now in post and visited the home on a weekly basis. At other times the staff encouraged the residents to take part in the activities programme, which was organised over a 4-week period and included, Giant crossword, Art and Craft, and Baking. The activities for week commencing 02 01 2006 were also audited. A November Newsletter giving information about the activity programme was evidenced. The Residents Notice Board provided information about Dial a Ride, visits by the library, the homes tuck shop and the activities programme. On the day of the inspection the residents had Steak pie, gravy, mashed potatoes, Brussels sprouts, and Swede for their lunch. Desert was meringue nests tangerine segments and cream. The food was well presented, and the three dining areas were comfortable and homely. Staff were observed to be available should any of the residents require help or support. One resident who spoke to the inspector said she had enjoyed her lunch and another said it was a very satisfactory portion. The autumn and winter menus were audited. Residents were asked each day for their next meal choices. Fruit juice was offered at lunchtime and an alternative meal choice was available. Aperitifs were also available eg.sherry and port. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 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): 18 Written procedures are in place, which promote the welfare of the residents. EVIDENCE: The Adult Protection and Prevention of Abuse Policies and Procedures were audited and contained information about the No Secrets Protecting Vulnerable Adults from Abuse Teesside Inter agency Policy and Procedures and Practice Guidance. There was evidence of appropriate training being provided and two members of staff who spoke to the Inspector confirmed they would know what to do should they have any concerns about a resident’s welfare. A whistle blowing policy was audited which was reviewed by the home in January 2005. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 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): 20 21 22 23 26 There are safe and comfortable indoor and outdoor communal facilities. Washing and lavatory facilities were clean warm and odour free on the day of the inspection. Specialist equipment was available to meet the needs of the residents. The residents’ rooms were personalised to meet their individual wishes and the environment was clean pleasant and hygienic EVIDENCE: On the day of the inspection the home was clean warm and odour free. A stair lift was provided for those residents who had difficulties gaining access to the first floor. On the day of the inspection the homes Maintenance records were evidenced and their Health and Safety Policies and Procedures, updated in January 2005, were audited. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 15 The Manger who spoke to the inspector confirmed the staff that use hoists have the appropriate training. An extractor fan had been fitted in the small area, which is used as a smoking room, and plans are in place for the room to be decorated, which will be incorporated into the planned expansion and refurbishment programme. The resident’s rooms were warm, and personalised. One resident had supplied their own bed; other residents had flowers and pot plants in their rooms, photographs and telephones. Plans have been drawn up for the home to have a sluice as soon as the extension / refurbishment programme commences. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 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 30 Staff is being trained to NVQ level 2 which should ensure they can meet the residents needs. The residents needs are met by the skill mix of staff who are trained, and competent to undertake their jobs. EVIDENCE: The Pre-Inspection Questionnaire said 86 of staff had been successful in obtaining their NVQ Level 2. Five members of staff are currently completing their NVQ Level 3 The manager informed the Inspector training had been discussed in the previous days staff meeting. Examples of training provided for staff included manual handling, first aid, food hygiene, fire training, basic life support challenging behaviour handling of medicines basic and food hygiene. An Induction Booklet was audited Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 17 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 36 38 The manager provides very good leadership to the staff team and continually strives to improve standards within the home ensuring residents needs are well met. The home is run in the best interests of the residents. The staff receive regular supervision. The manager ensures as far as reasonably practicable the health safety and welfare of residents and staff. EVIDENCE: The Registered Manager is completing her NVQ Level 4 in management Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 18 The Homes Health and Safety Policies and Procedures were audited. The pre inspection questionnaire contained information about staff whom had undertaken training in manual handling and lifting, basic life support-appointed first aid, fire training and health and safety. A Quality Assurance Audit was undertaken by the home which included the views of external agencies, residents, family members and staff .The 2005 report when complete will be available to anyone who makes a request. The manager who spoke to the inspector confirmed all staff appraisals and supervision were up to date. One member of staff who spoke to the inspector said she had received supervision. The other member of staff who spoke to the inspector explained she had recently been appointed and had spent her first week with identified members of staff. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 3 10 X 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 X 17 X 18 3 X 3 3 3 3 X X 2 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 3 X 3 Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 20 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 OP26 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 29/06/06 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 OP26 OP31 Good Practice Recommendations The registered person should decorate the area that is used by those Residents who smoke. The Manager should pursue the completion of obtain her NVQ Level 4 in management. Loxley Chase DS0000039334.V258799.R01.S.doc Version 5.1 Page 21 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
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