Inspection on 18/08/06 for Ludlow Lodge Care Centre

This inspection was carried out on 18th 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ludlow Lodge Care Centre 21/05/07

Ludlow Lodge Care Centre 02/12/05

Ludlow Lodge Care Centre 30/06/05

Ludlow Lodge Care Centre 21/02/05

Ludlow Lodge Care Centre 03/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ludlow Lodge Care Centre Ludlow Lodge Alcester Road Wallington Surrey SM6 8BB Lead Inspector David Pennells Key Unannounced Inspection 18th August 2006 12:15p 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 Ludlow Lodge Care Centre DS0000038481.V310258.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. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ludlow Lodge Care Centre Address Ludlow Lodge Alcester Road Wallington Surrey SM6 8BB 020 8669 7260 020 8773 1215 richard.low@sutton.gov.uk 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) London Borough of Sutton Mr Chen Heng Low Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ludlow Lodge is registered for 33 permanent service users and 8 respite care service users. 2nd December 2005 Date of last inspection Brief Description of the Service: Ludlow Lodge is a substantial residential home now providing care and accommodation to a diminishing number of older physically frail people; the number reduction is part of a phased plan to make way for the introduction of an intermediate care service to be provided on the first floor of the home from early 2007. The home is owned, managed and maintained by the London Borough of Sutton’s Community Services Department. The home is located off a busy main arterial road linking Croydon and Sutton to Wallington - the town centre of which, is close by - providing good transport links. The home is laid out on 2 floors, the upper floor being accessible by passenger lift. All bedrooms are single occupancy; some previously undersized double occupancy bedrooms now make attractive single rooms. The home is split into smaller living units, providing a distinct ‘group living’ model of care, each unit having a member of staff allocated - per shift - to support service users, with additional ‘floating’ staff when needed. Each unit has its own lounge, dining area and separate bathing and toilet facilities; there is also a small kitchen in each unit, where breakfasts and snack meals are freshly prepared. The home has a large central kitchen, where the main meals of the day are prepared and then distributed to the units and also to the attached day care centre. The home’s day centre, which is attended from home by local Sutton residents, provides a service to some residents of the care home - if they wish to use this service, and / or if they did so in the past. This home is currently expecting to ‘amalgamate’ with the Bawtree House intermediate care service by, at latest, 31/03/07 - this due to the closure of the latter; the intermediate care service will be provided to service users on the upper floor. As the numbers of service users have reduced, current service users at Ludlow have been supported to handle these changes. Some service users have already (often with support from relatives and the social services department) elected to ‘move on’. A significant number of service users however have elected to stay - although the long-term future of Ludlow as a long-term care home is to be agreed after further consultation once this ‘phased’ move has been completed. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home was conducted over a period of five and a half hours when the inspector was able to engage with service users, staff members, the home manager and some visiting relatives - as well as touring the premises. The feeling generally received from enquiries was a positive view - borne out by written questionnaires received back from relatives - terms such as ‘excellent care’ and ‘best care’ reflecting the confidence of those who entrust their loved ones to the staff and the service at the home. Although 40 of the relatives questioned felt that there were not always enough staff members on duty, they nonetheless all stated they were, overall, satisfied with the level of care provided. Four GPs (from three different local practices) kindly responded to the Commission’s direct approach concerning how they found the service provided at the home; they, without dissention, indicated their happiness with the service provided - commenting on communication, assistance from staff, plans of care, promoting privacy, medication administration, and complaints. One GP commented: ‘They take good care of residents.’ What the service does well: What has improved since the last inspection? Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 6 Part of the planned refurbishment of the home has led to the passenger lift being entirely refurbished; this has ensured that the noisy mechanism has been replaced and the car is now more comfortable and user friendly for travel. The call bell provision within the entire establishment has been changed to an integrated ‘bleep’ system - which has reduced the disturbance from the previously intrusive hard-wired system. In response to concerns about break-ins to the home (and other care units in the local area) by a specific (caught and now being convicted) burglar, the home has upgraded its security provisions throughout the home and day centre areas; all windows have window restrictors, and doors are connected to the call bell system. A requirement that the system of long term safe keeping of monies be improved with regard to service users being provided with regular statements of their assets being held by the council - and of interest awarded to these accounts - has now been fully met - with quarterly statements addressed to the individual service user being introduced. All bedrooms and lounges have now been fitted with the ‘dorgard’ facility which enables the door to be held open until such times as a fire emergency is alerted by the fire bells. Written care planning systems were comprehensively maintained with a clear focus - and the reported reality of staff is that more 1:1 ‘quality time’ is possible, now that there is a higher-than-usual staffing ratio providing a service to the reduced number of service users. Recording within the home was noted to be receiving more positive attention. Staff training input has been increased in preparation for the blending of the two care home teams - from Ludlow Lodge and Bawtree House; a wide variety of input - including focusing on person-centred support has been commenced. The home has also applied to the Commission for, and gained, a variation to its registration to provide a respite care service in a seven-bedded unit on the first floor - this being a self-contained unit, which allows for independence of this unit without interfering with the space reserved for the permanent service user group. The respite care service has been registered to run alongside, but without interfering with, the permanent care service since the end of April 2006. At the time of the inspection visit this Unit had not yet been opened. What they could do better: Regulation 26 visits by a representative of the registered provider must be conducted on a monthly basis, with written evidence being provided to the Commission local office. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 7 The local authority is also required to review their approach to the use of the ‘emergency room’ - Room 3 - which is significantly under National Minimum Standards and should really be withdrawn from potential use. As a recommendation, it is suggested a stronger focus on ‘equality, cultural and spirituality’ issues be incorporated in the care planning document - to provoke closer examination of these vital areas. There is also a recommended need for a review of furniture and furnishings throughout the ground floor accommodation - whilst the first floor is being upgraded for the introduction of the intermediate care service, the permanent service users must not be allowed to miss out on the home’s improvements. 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. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 8 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 Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 9 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 & 6. The home’s process for assessing prospective service users (currently only new short term placements) - and subsequent decisions about their future - takes into account the factors that are identified through the detailed exploration of needs, both written and spoken. Staff members clearly have the collective skills and experience to deliver a service to a good standard for dependent ‘older people’ living at the home. Ludlow Lodge does not provide an intermediate (rehabilitative) care service; therefore Standard 6 does not apply. Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. EVIDENCE: No new permanent admissions have been made to the home, however some service users have arrived on ‘limited term’ contracts. The home has a comprehensive Statement of Purpose that contains all elements as required in Regulatory Schedule 1. The home’s Service User Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 10 Guide, written in a relevant format, contains a summary of the service user’s views of the home, and also the home’s / Borough’s Complaints procedures. This is made available to all prospective and current service users. Documents such as this are kept openly available to any interested enquirer in the front hallway of the home, where visitors ‘sign in’. The manager confirmed – and the inspector was able to find – that all new temporary placements at the home were furnished with full assessment documents – this enabling the home, along with the familiarisation documents, to ensure that a plan of care had been devised for the point of admission. A familiarisation / ‘Social History’ document has been introduced - for staff to get to know service users better in the initial days of their stay; it is designed to collect the ‘soft’ or ‘informal’ information intended for staff who are expected to provide an individualised / informed 1:1 service to this individual. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 11 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. Individual Care Plans are provided for service users from ‘Day 1’, with a full assessment informing the full focus leading to a plan of action. The health care needs of service users are adequately and very individually met; the home respects the right to choice of GP, and facilitates this through keeping contact with many surgeries in the local area. The service is well respected by local general practitioners – indicating a focused and correct approach to healthcare needs by the home. The storage, administration and recording of medication is generally well ordered, with staff well trained and supervised - to ensure a safe service. Staff members relate respectfully and appropriately to service users, protecting the dignity and privacy of each service user. Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 12 EVIDENCE: Written care planning systems were comprehensively maintained with a clear focus - and the reported reality of staff is that more 1:1 ‘quality time’ is possible, now that there is a higher-than-usual staffing ratio providing a service to the reduced number of service users. Recording within the home was noted to be receiving more positive attention - and was consequently of a higher quality. Comprehensive Care Plans provided by Care Managers are now actively sought and required prior to the date of assessment of a service user, thus enabling staff members to have information about individuals when they are admitted to the care home. Risk and other assessments are now being completed as soon as practicable after an admission. It was noted that reviews of assessments and care plans were being regularly undertaken and documented. The care generally provided by staff to service users was reported by the latter to be good; this was borne out by written questionnaires received back from relatives - with terms such as ‘excellent care’ and ‘best care’ reflecting the confidence of those who entrust their loved ones to the staff and the service at the home. A new ‘Malibu’ assisted bath had been commissioned recently; this has enhanced the facilities available to service users and encourages greater choice in bathing location. Four GPs (from three different local practices) kindly responded to the Commission’s direct approach concerning how they found the service provided at the home; they, without dissention, indicated their happiness with the service provided - commenting on communication, assistance from staff, plans of care, promoting privacy, medication administration, and complaints. One GP commented: ‘They take good care of residents.’ Medication administration processes audited during the inspection visit were managed correctly and recording seen was concise and accurate. The interaction between staff and service users was observed on a number of Units; it was familiar, friendly but respectful. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 13 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 - 15. Activities and general lifestyles at the home provide for meeting the individual needs of service users, thus providing a level of fulfilment and satisfaction. Contact with the local community and friends / family are positively encouraged, this bringing the home into the community - and vice versa. The home seeks to ensure that autonomy and choice are afforded throughout the home; personal items and furniture lend a personal air to bedrooms and service users are encouraged to express themselves individually - recognising their cultural and spiritual needs. Service users have clearly been kept informed about the ‘reprovision’ changes at the home - this leading to them feeling ‘at peace’ with the pace of change surrounding them. The food provided at the home is wholesome and nutritious; choice is provided and individual preferences are acknowledged through the small ‘Unit living’. Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. EVIDENCE: The service at Ludlow Lodge has the ‘added quality’ element of the day care culture running alongside the care home itself, and which a number of service Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 14 users engage with. This instils a sense of ‘life’ in the home that is rarely evident in ‘stand alone’ homes, and bodes well for integration with the (more dynamic) intermediate care service, which is to join Ludlow in early 2007. In the meantime, a greater opportunity for quality 1:1 time is possible, as the service user group reduces. Service users can access hairdressing at a reasonable rate within the home; toiletries, newspapers and other luxuries can be obtained, as required. Activities arranged by the home include Barbecues, outside entertainments (often as a joint venture with the day centre), and various local parish church activities are available. Outings are organised by staff. Internal home activities include: Bingo and Card games, Exercise Classes, Sing-a-longs, Reminiscence Sessions and twice-weekly Video Film Shows. Birthdays are celebrated – where appropriate - with a Unit party. Some service users who have no clear representative in the guise of relatives or close friends – are connected with Advocates through Sutton Age Concern. Service users who have in the past used the Ludlow Day Centre still maintain a right to the service, this ensuring continuity of friendships / activity / outward perspective. An Asian service user attends a culturally-appropriate club on a regular basis, to maintain links with his racial, religious and social roots. One service user speaks a Ugandan dialect language - the home has located staff / district nurse and agency workers who speak her specific language which helps to supplement the small amount of English they have. Specific food provided to their cultural preference - as also to the Asian background service user. A recommendation in this report suggests a stronger focus on ‘equality, cultural and spirituality’ issues in care planning - to provoke closer examination of this area within the home; such a focus for each individual should reveal the benefits of making focused enquiry in these areas. A wide variety of food is provided; the kitchen currently only catering for 23 from the home and 25 (maximum) in the day care centre. This means that the catering staff find it easier to respond to individually expressed preferences. Dining areas in the Units are pleasant to sit in and friendly and homely especially when the community comes together for their main meals. The menu plan was displayed in the Unit kitchens and seen to offer a choice of food throughout the week - and also addressed individual dietary needs. Service users are asked what they would like to have to have, or select the choice from the menu on a daily basis. Breakfasts are served very informally on the Units, using provisions stored in the small Unit kitchens / refrigerators. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 15 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 & 18. Service users can be confident that they are protected from abuse and that their rights to complain will be respected and that such expressions of concern / complaint will be acted upon and dealt with in a timely and appropriate manner. Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. EVIDENCE: The manager confirmed that there had been no complaints received by the home since the last inspection visit and no restraint or adult protection issues had arisen. The home has a formal complaints procedure in place; the manager strongly believes in ensuring that issues are resolved at the first opportunity at the local level. Records showed that previous complaints had been dealt with appropriately, with deadlines heeded and all stated action taken by the home if any. The home has now developed an accessible complaints procedure for service users. Advocacy services are provided by the local Age Concern for service users without relatives / interested parties to discuss the ongoing transformation of the home’s purpose at Ludlow. The home has an Adult Protection and Whistle Blowing policy and procedure the corporate multi-agency Vulnerable Adult policy. Senior staff and many other staff members have attended the Borough’s Adult Protection training. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 16 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, 22, 23 & 26. Service users can rely upon the home being well maintained to a generally safe and comfortable level, with generally appropriate furnishing and adequate facilities to meet their individual needs. Recent capital works have enhanced the facilities provided at the home considerably. Consistent ongoing maintenance and servicing inputs from the home’s staff - and other professionals - ensures the service users’ health & safety. Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. EVIDENCE: There are currently 41 places in single bedrooms registered at the home; two have ensuite facilities, 25 are under the now minimum size standard - but as an existing home they continue to be permitted to be used. There are six Unit areas with eight lounges and a visitors’ room provided. The home is a pleasant modern establishment inside – though the external feeling of the house is somewhat plain and gloomy. Looking out from the home Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 17 is quite a different experience! The home is designed to facilitate group living within six units - and all areas are accessible to service users. The home’s decoration and refurbishment - by the prudent activity of the home manager – remains in relatively good condition throughout. The use of the significantly smaller bedroom (8.6 sq.m. – designated to be solely occupied by short-term / emergency / respite admissions) must be reconsidered -in the light of the refurbishment project for use other than a bedroom due to its poor space size. The registered provider is asked to ensure - through a recommendation - that they review the downstairs furniture and furnishings - to ensure they ‘keep up’ with the rest of the refurbishment work at the home. The home provides one assisted bath in each of the six units. A ground floor accessible toilet is available on the ground floor for service users and any other disabled person visiting the home. This has been created out of two smaller toilets - and is no doubt a great benefit to all who find it easier to use rather than the previous inadequate / small facilities. The home has access to Occupational Therapy services in order to assess the needs of individual service users, and the home uses mobile hoists for moving and handling purposes. An induction loop system is installed in each of the service user’s sitting rooms - to enable better hearing for hearing aid users. Part of the planned refurbishment of the home has led to the passenger lift being entirely refurbished; this has ensured that the noisy mechanism has been replaced, and the car is now more comfortable and user friendly for travel. The call bell provision within the entire establishment has also been changed - to an integrated ‘bleep’ system - which has reduced the disturbance from the previously intrusive hard-wired system. Also, all bedrooms and lounges have now been fitted with the ‘dorgard’ facility, which enables the door to be held open until such times as a fire emergency is alerted by the fire bells. In response to concerns about break-ins to the home (and other care units in the local area) by a specific (caught and now being convicted) burglar, the home has upgraded its security provisions throughout the home and day centre areas; all windows have window restrictors, and doors are connected to the call bell system. Capital works concerning re-securing roofing - and improving the quality of lighting throughout - and also unit redecorations will be undertaken from October 2006. The home had applied to the Commission for, and gained, a variation to its registration to provide a respite care service in a seven-bedded unit on the first floor - this being a self-contained unit, which allows for independence of this unit without interfering with the space reserved for the permanent service user Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 18 group. The respite care service has been registered to run alongside, but without interfering with, the permanent care service since the end of April 2006. At the time of the inspection visit this Unit had not yet been opened. The courtyard and garden areas are well appreciated by service users, and were being used to ‘cool down’ on the hot days experienced around the inspection visit day. The immediate outlook to the gardens is pleasant, and it remains no surprise to the inspector that the majority of service users spoken to remained happy with the decision to occupy the ground floor if they had to be moved to a certain ‘sector’ of the home pending the advent of the Bawtree House service. The house was generally clean and odour-free throughout at the time of the inspection. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 19 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 - 30. The staffing input at the home is provided in numbers and skills-mix to a level that generally meets the assessed and recorded needs of service users. Staff members are generally sufficiently trained - both in local and vocational disciplines - and suitably supervised to ensure that the service users are in safe and competent hands at all times. The registered provider supports the home through its recruitment and employment procedures and practices to ensure that diversity and equality is promoted and that service users are protected from potentially abusive staff. Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. EVIDENCE: To cover the four currently operational living units at the home, 20 permanent care staff and nine ancillary staff are employed. Two night staff are available, awake, each night - with a senior on call. Currently three permanent night agency staff members cover for posts that will be covered, in future, by Bawtree night staff - when they move over to Ludlow Lodge in early 2007. Other than this ‘temporary’ cover, the home finds it now uses agency workers very occasionally - generally now only in a crisis. There have been three retirements from the home in the past year. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 20 Staff members were very much appreciated by service users: a previous comment recorded: ‘They’re real friends once you get to know each other’ still bears itself out by a number of comments made by service users. Although 40 of the relatives involved with the home questioned felt that there were not always enough staff members on duty, they nonetheless all stated they were, overall, satisfied with the level of care provided. The ‘problem’ with unit living is the visibility of staff when not immediately ‘in situ’ where a visitor may be located. As part of the staff integration strategy, training is being introduced to all care staff to ensure that as the two teams join up they all are ‘singing from the same song book’; an excellent staff training strategy so far covering Adult Protection / Infection Control / Care of Medication / Person-centred support has been introduced. It is understood that staff training expectations in future will expect basic competence in Effective Communication / Infection Control / Manual Handling / First Aid / Food Hygiene / Adult Protection and Person-centred Care Planning. All permanent care staff are trained to administer medication - and seniors have been trained in reviewing / assessing staff competency in this particular important area. A full staff training record / matrix was available for the inspector’s perusal. Twelve (with three more pending) care staff have qualified [minimally] to Level 2 NVQ in Care; this being well over the 50 minimum standard set (it’s nearer 75 ). The goal is for all care staff in Council’s care centres to have an NVQ. New corporate induction processes are also being introduced - it is the manager’s intent that this will be phased in to the home for all staff. Staff members have also been provided with a ‘suggestion box’ (as well as the more ‘formal’ routes of consultation and 1:1 supervision) for eliciting ideas as to how the two teams can come together to provide the best possible service for the future. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 21 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 & 38. The manager is suitably qualified and competent to ensure that the overarching service is provided in a professional and service user-focused manner. The service provided is run in the best interests of the service users, and would benefit from regular unannounced visits from a representative of the provider. Service users can be confident that their financial interests will be safeguarded by the home’s appropriate management and accounting / financial procedures. The registered provider, through a process of updating policies and procedures, has ensured that best practice is known and adopted, based on this new documentation. Service users will benefit from this new information being available to staff and other stakeholders. The registered provider positively promotes the health & safety of service users and staff through regular maintenance and checks of facilities. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 22 Quality in this outcome area is good. This judgment had been made using evidence gathered both before and during the visit to this service. EVIDENCE: The manager, Richard Low, oversees the entire service at Ludlow Lodge – including the day care service - managed on a day-to-day basis by one of the home’s senior staff. Mr Low is a registered Mental Health Nurse; he also has a CQSW (Certificate of Qualification in Social Work), and holds the CMS (Certificate in Management Studies). He also has many years of hands-on experience. The home has an effective management structure with both a manager and deputy manager (also a recently qualified social worker), and with senior carer staff managing the units and associated teams of staff. Areas such as Medication, Staff training and Activities & Outings are designated areas held in additional responsibility by each senior carer. The home has its own quality assurance surveys in place concerning activities and meals and other elements; the manager finding that a ‘single focus’ survey elicits a better response than a generic multi-subject questionnaire. The Council, as registered provider, is required un Regulation 26 - to ensure that a monthly unannounced visit is made to the home by an appointed representative to inspect the conduct of the home -and to make a report of this visit for the information of the registered provider and the Commission. Previous requirements set by this inspector had, it was thought, resolved the issue of lack of such visits, the Inspector assuming that implementation would be constant - however, though regular at end of 2005 and in January 2006, only one other inspection visit record existed for the subsequent months - for May 2006. Clearly, the required visit has not been happening in a formally structured way, again, though the Provider Service Manager (now Ms Sandra Roche) has undoubtedly been visiting the home. The inspector was again assured that an independent person will be conducting these visits on behalf of the registered provider. The home manager confirmed that he now has to complete a monthly self-assessment form on behalf of the home for the organisation - this will form the future basis of discussions about the conduct of the home. It is important that copies of the visit reports be forwarded to the Commission as evidence of such compliance. The financial interests of service users are well safeguarded by the home; the accounting of monies at the home held in safekeeping and local administration processes have been previously examined and found concise and well maintained. Service users sign individual receipts to receive monies paid as personal allowance; transactions with service users are undertaken in the home within a context of privacy and appropriate management. The provision Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 23 of single occupancy rooms throughout the home equally provides for the respect for, and protection of, each individual’s security and privacy. Six service users have their affairs managed by the by the Council’s Client Officer. A requirement that the system of long term safe keeping of monies be improved with regard to service users being provided with regular statements of their assets being managed by the Council - and of interest awarded to these accounts has now been fully met - with quarterly statements addressed to the individual service user being introduced. The inspector found all in-house and external maintenance and servicing of the premises were up-to-date and evidenced through well kept and ordered records most kept in a premises manual. Such measures ensure the safety of service users. The manager has more recently completed a certified IOSH Course in ‘Managing Safely’. First Aid input at the home is provided generically at all times by the senior staff - all holding current First Aid qualifications. Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 24 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 Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 25 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 3 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 X X 3 2 X X 3 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 2 X 3 X X 3 Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 26 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 OP23 Regulation 23(2)(f) Requirement The use of the small bedroom known as the ‘emergency room’ must be reviewed for adequacy of size & facilities and preferably withdrawn from use. Regulation 26 visits by a representative of the registered provider must be conducted on a monthly basis, with written evidence being provided to the Commission local office. Timescale for action 30/11/06 2. OP33 26 30/10/06 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. Refer to Standard OP12 Good Practice Recommendations That a stronger focus on ‘equality, cultural and spirituality’ issues be provided in the care planning section - to provoke closer examination of all elements in this area. That the downstairs furnishings & furniture be reviewed to ensure that all parts of the home are kept to the same quality standard. 2. OP22 Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 27 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 © 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 Ludlow Lodge Care Centre DS0000038481.V310258.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!