Inspection on 30/06/05 for Ludlow Lodge Care Centre

This inspection was carried out on 30th June 2005.

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

Ludlow Lodge Care Centre 21/05/07

Ludlow Lodge Care Centre 18/08/06

Ludlow Lodge Care Centre 02/12/05

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 Alcester Road Wallington Surrey SM6 8BB Lead Inspector David Pennells Announced 30 June & 1 July 2005, 09:30 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 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 G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ludlow Lodge Care Centre Address Ludlow Lodge, Alcester Road, Wallington, Surrey, SM6 8BB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8669 7260 020 8773 1215 richard.low@sutton.gov.uk London Borough of Sutton Mr Chen Heng Low Care Home 42 Category(ies) of Old age (42) registration, with number of places Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 21/02/05 Brief Description of the Service: Ludlow Lodge is a substantial residential home now providing care and accommodation now to 41 older physically frail people (one - being a particulalrly small room only being allowed for use on a respite basis). It 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 centre of which is close by. The home is laid out on 2 floors, the upper floor being accessible by passenger lift. All bedrooms are now single occupancy; the small double occupancy bedrooms having been withdrawn from such use - now making attractive single rooms. The home is split into six living units, providing a distinct ‘group living’ model of care, each unit having a member of staff allocated - per shift - to support service users. Each unit has its own lounge, dining room and bathing facilities; there is also a small kitchen in each unit, where breakfasts and snack meals are prepared. The home has a large central kitchen where the main meal of the day is prepared and then distributed to the individual units and also to the attached day care centre. The home’s day centre, which is also attended by other local Sutton residents, provides a service to some residents of the care home - if they wish to use this service, and did so in the past. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit lasted over two working days and the home’s manager was available to assist the inspector on both days. As well as spending time reviewing the minimum standards and previously set requirements and recommendations with the manager, the inspector spent a significant amount of time meeting service users – both over two mealtimes and also while moving unescorted around the entire home. One major reason for spending a significant period of time with service users was to receive opinions on the concept of another home owned by the provider (Bawtree House) being moved in to ‘share’ the site of the home with Ludlow Lodge. The Bawtree House service is based on short-term ‘intermediate care’ – providing a rehabilitation / halfway service to older people being discharged from hospital. The concept would rely on the Ludlow population reducing – in time - to provide approximately 50 of the space to the Bawtree service. The London Borough of Sutton’s Community Services Dept had been consulting both service users and staff on this issue, and clearly the inspector wished to be assured that everyone had had the opportunity to contribute to the debate. This was found to be so, with some being very concerned, and some ‘shrugging off’ the idea as presented. The overriding opinion, however, was that service users were content that things should change ‘around them’ – and many fiercely stated they were keen to stay in their own areas in the home – especially those situated on the ground floor – who did not want to lose their views and direct access to the garden areas. Eleven relatives / friends replied to the Commission’s general questionnaire. Of those responding to each question, all felt welcomed in the home, able to see their relative in private, were kept informed about issues affecting their loved on e and were consulted about their care. The poll was evenly split on whether there were sufficient staff members on duty at the home. The opinions were also evenly split between those who knew of the complaints procedure and those who did not. Happily, only three indicated they had ever had to make a comment / complaint. All but one respondent felt that the home provided, overall, a satisfactory service of care. Nine service users responded to the Commission’s questionnaire: Seven liked living at Ludlow, one did not, and one liked it ‘sometimes’. Six felt well cared for and three felt this ‘sometimes’. The same figures applied to being treated well by staff. Seven felt their privacy was respected; one did not, and one felt this was so ‘sometimes’. The slightest majority felt they should be more involved in decision-making in the home. Eight out of the nine felt there were suitable activities at the home – one only ‘sometimes’. Six enjoyed the food, Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 6 three scored ‘sometimes’. Most service users knew who to speak to if they were unhappy about their care – and, perhaps most basically and importantly, all nine of the service users felt safe at the home. What the service does well: What has improved since the last inspection? What they could do better: The inspection visit revealed that assessments, prior to a service user’s admission, need to be thoroughly undertaken – to inform the developing care plan. Care plans also need to be in place – at least in draft form – from the start of the placement. The inspector was concerned that a service user who was admitted to the undersized respite care bedroom on an emergency basis was now being regarded as a permanent resident – despite his still occupying this small bedroom and despite – more importantly – his being inappropriately placed (clearly ‘out of category’) in the first place. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 7 Attention to the medication administration procedure is needed to ensure that the system, as arranged, supports the recording and ensures a fail-safe system. Security of the lockable Unit medicine cupboards must also be monitored. Personal toiletries and care items must be clearly marked, and kept for individual personal use only; each service user has their own room in which to keep them now. The keeping of items in communal areas must be discouraged. Details of a service user’s - or relative’s ‘wishes’ with regard to steps to be taken if a service user falls seriously ill, or passes away, are still to be recorded. The appropriate provision of care to service users – to meet specific identified needs – leads the inspector to require that staff are appropriately trained and sensitive to the more individual needs of certain specific service users. Whilst the home is kept generally very clean, cross-infection risks were identified in bathrooms – requiring more focused attention. The passenger lift and call bell system have been identified as important areas for attention – both being antiquated and in need of urgent renewal – especially if the home is to provide a renewed service consequent to the Borough’s reprovision plans. Regulation 26 requires that a representative of the provider visits the home on an unannounced basis and a report is made on the conduct of the home – being copied to the Commission. These have yet to be implemented. Finally, the need for service users who have monies held in safekeeping by the Borough to have regular statements – reflecting the awards of interest – is required – thus ensuring a transparent service in this regard. 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 G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 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 standard(s) 1, 3, 4, 5 & 6 The home provides information in an accessible format for prospective service users and their relatives / friends, ensuring that a choice to enter the home is made with sufficient information. Service users can be assured of a warm welcome and caring attention from staff at the home on admission, however this process would be enhanced if the home focused more on ensuring sufficient assessment information is obtained prior to and at the actual point the admission – thus ensuring a more focused and individual service. Staff members clearly have the collective skills and experience to deliver the service to a satisfactory standard for ‘older people’ at the home. The home’s process for assessing new service users with special needs - and subsequent decisions about their future - has not taken into account the registration category of the home, nor the specialist needs that might be required. This can lead to a mismatch of care input. Prospective service users, relatives and friends are able to visit the home prior to a possible admission being arranged. Ludlow Lodge does not provide an intermediate (rehabilitative) care service; therefore Standard 6 does not apply. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 10 EVIDENCE: The home has a comprehensive Statement of Purpose that contains all elements as required in Schedule 1. The home’s Service User Guide, written in a relevant format, contains a summary of the service user’s views of the home, and also the home’s complaints procedure. It is made available to all prospective and current service users. Documentation such as this is kept openly available to any interested enquirer in the front hallway of the home. A service user with learning disabilities had been admitted temporarily to the home on an emergency basis - on 25 February 2005. This service user had occupied the inadequately sized ‘emergency’ room since that date to the end of June 2005 – and the inspector was informed that the placement had now been made permanent. On more than two counts, this situation is unacceptable; firstly, the small respite /emergency room is designated for emergency / very short stays only. Secondly, a service user who has a learning disability diagnosis - and is under the care of the Learning Disability Team – should only have been considered for long-term placement ‘out of category’ through a formal application to the Commission for the consideration of a Variation to the home’s registration. In this case, no confirmation of placement should have been made until such times as a Variation had been granted / refused. Thirdly, the admission should only have been made on the basis of the home having staff competently trained in a skills base of learning disability issues. The inspector had concerns that there was little sign of the home’s own assessment visit on file, and it was noted that Comprehensive Assessments provided by Care Managers are sometimes provided post-admission. On some files there was no clear guidance relating to a service user that staff members could ‘hit the ground running with’. Risk assessments / agreements were one of the most commonly completed forms, but these were sometimes undated or not signed, this reducing their usefulness. This is worrying, as often the dayto-day notes description of a service user over the first week or so of their stay gave little clue as to how that person was settling in. The staff member apparently, therefore, relies on hearsay or informal anecdote. A ‘familiarisation profile’ is suggested - for staff to get to know service users better in the initial days of their stay - designed to collect the ‘soft / ‘informal’ information for staff who are expected to provide an informed service to this individual. The home then invites the prospective service user to visit the home; to see the establishment and to ‘sample’ the way of life – including, if need be, and felt appropriate, an overnight stay. A service user - relatively recently admitted to the home – was full of praise for her admission process and the staff on their Unit: ‘They made me very welcome – they’re very friendly.’ Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 & 11. Individual Care Plans are provided for service users but the home should seek to ensure that a provisional plan is in place on day one of an admission – so that focused and appropriate care can be provided from ‘Day 1’. 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 and administration of medication is generally well ordered, however staff training must emphasise the issues of ‘sticking to the system’ correctly and security. Staff generally relate respectfully and appropriately to service users themselves, however more care should be taken to protect the dignity and privacy of each service user by avoiding the use / storage of personal items in a ‘communal way’. The home provides a sensitive and caring approach to service users who are seriously ill / close to death; this process could be further enhanced through the home having more focussed information relating to a service user’s, or their relative’s, wishes to be followed at this time. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 12 EVIDENCE: Concern about care plans being evolved over time - and thus a clear plan of care not being available to support service users and staff at the point of admission - were borne out by examination of the entire documentation held for some service users, which showed that at times the first care plan was established some time after admission. Some ‘Comprehensive Care Plans’ provided by Care Managers were clearly not provided until after the date of admission of a service user, thus leaving staff to ‘find out’ about individuals admitted to the care home. Other documents – such as risk agreements and other assessments seemed also to have been undertaken at dates within the first four to eight weeks following an admission, rather than there being a need to complete such documentation as soon as practicable after an admission. An ‘emergency’ admission to the home from another care home inexplicably had no guidance from the previous establishment as to how the service user was progressing up to the point of moving. A general written ‘profile’ was all that was available – or had been sought – by the home. The service user had also been known to social services for many years; but little had been sought from any ‘archive’ that might be available of the PARIS information system now used by the Borough as its main information resource. Relatives commented about the service provided: ‘The care and attention given is beyond reproach. There is a genuine personal attention given by the wonderful staff to the residents’ – ‘Since my Mum has moved into Ludlow Lodge I have noticed a change in her for the better. I cannot fault the staff and the personal care she receives.’ One opinion was a little mixed: ‘Usually my relative’s care is very good – though I do feel some remembers of staff rush them.’ A service user commented: ’The staff are very kind and considerate.’ Access to GPs is wide; twelve different individuals are named against service users names in the pre-inspection questionnaire, reflecting representation from nine different surgeries in Carshalton, Sutton, Wallington and Hackbridge. Three GPs took the time to respond to the Commission’s questionnaire – all being clear that they were happy with the service provided at the home. Staff members were described as ‘hardworking’ – with a ‘close working with practitioners’. Another commented: ’Staff appear to look after residents well; always know what problems residents have. Building clean and tidy.’ All permanent staff administer medication to service users - they have all received in-house training and an external company is planning to introduce training. One service user manages their own medicines. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 13 Random inspection audits on a Unit’s Medication results in a requirement that medication must be administered according to the procedure commonly adopted for the monitored dosage system of administration; without systematic administration errors can easily creep into the system. In relation to this audit, in one case more signatures than tablets dispensed from the ‘blisterpack’ were found, and in another tablets dispensed from the ‘blisterpack’ only randomly, rather than accurately representing the days when a service user had been in hospital - leading to there not being tablets for the ‘end of the week’ on the right day in this system. The issue of maintaining privacy and dignity for service users was contradicted by the inspector finding numerous unmarked personal care items – including prescription cream (belonging to an ex-resident) being openly in bathroom areas – leading one to conclude that they are perhaps used communally. Five service users have passed away at the home in the past year, and also three in hospital. Three service users had also been transferred to nursing care settings when the need for extra care exceeded that which the home could properly provide. Two further service users had been assessed for a possible move, due to failing abilities. The previous requirement to ensure that detail concerning each service user’s – or their representative’s wishes in respect of steps to be taken should they fall seriously ill, or pass away, had yet to be fully implemented. The manager assured the inspector that a new policy was currently being written and work would focus down on this requirement as a consequence. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 14 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 standard(s) 12, 13, 14 & 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 special needs of some more isolated service users may well be met if more focused training is provided for staff – leading to a more individualised service. 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. Consultation with service users over projected major changes to the home over the next few years has been conducted systematically and sensitively; although community meetings and individual encounters had been facilitated, service users felt they had ‘been consulted’, but were ‘somewhat powerless’ at the same time. Reassurance that service users will be involved in the ongoing process has provided some sense of security for the future. The food provided at the home is wholesome and nutritious; choice is provided and individual preferences are acknowledged through the small ‘Unit living’ style of dining. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 15 EVIDENCE: 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, and outside entertainments are arranged as a joint venture with the day centre on site. Various local parish church activities are available. Outings (such as to the London Eye in May and Brighton in June) are organised by staff. Internal activities include: Bingo and Card games, weekly Exercise Classes, Sing-a-longs, weekly Reminiscence Sessions and twice-weekly Video Film Shows. Birthdays are celebrated – where appropriate - with a Unit party. Service users who have in the past used the Ludlow day centre still maintain a right to the service – ensuring continuity of friendships and activity. An Asian service user attends a culturally-appropriate club on a regular basis, to maintain links with his racial, religious and social roots. The inspector was somewhat surprised to encounter a carer using disrespectful language to challenge a very aged service user, on the basis of the sounds she made whilst sitting alone and unoccupied in an armchair in an empty lounge. The inspector felt this approach evidenced a lack of understanding of the individual’s needs and a limited ability to communicate effectively and respectfully with the said service user. Some service users who have no clear representative in the guise of relatives or close friends – are connected with Advocates through Sutton Age Concern. The idea of belonging to the home and it being – definitely - ‘home’ (with all the connotations of security and permanence that word suggests) was a key factor to a number of service users. One service user – echoing the spoken concerns of a number of service users - stated (concerning the possible changes imminent at Ludlow Lodge): ‘Fortunately, I have a very nice room, which I have made my home and pray to God I can end my days here. I love the outlook from the window and have access to the garden - which I enjoy when the weather allows.’ Dining areas in the Units are pleasant to sit in and friendly / homely when the community comes together for the main meals. The meals generally were spoken of to be a well-cooked quality. The menu plan was displayed in the Unit kitchens and seen to offer a choice of food throughout the week - and 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 informally on the Units using provisions stored in the small Unit kitchens / refrigerators. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 16 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 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. EVIDENCE: The home has a formal complaints procedure in place - and no complaints have been received within the past year; 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. The home has an Adult Protection and Whistle Blowing policy and procedure the corporate multi-agency Vulnerable Adult policy initiated by the registered provider – the London Borough of Sutton and agreed with independent providers. Senior staff and many other staff members have attended the Borough’s Adult Protection training. Financial transactions with service users are undertaken in the home within a context of privacy and appropriate management. The provision of single occupancy rooms throughout the home provides for the protection of individual’s security and privacy. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 17 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 standard(s) 19 - 26 Service users can rely upon the home being well maintained to a generally safe and comfortable level, with appropriate furnishing and adequate facilities to meet their individual needs. Consistent ongoing maintenance and servicing inputs from the home’s staff and other professionals ensures the service user’s health & safety. Some attention does need to be paid to thorough cleaning to avoid issues of possible cross-infection. The home does also need, in the near future, to address the need to replace some major facilities – such as the passenger lift and emergency call bell system – both reaching the end of their effective lives. EVIDENCE: 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 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 – was in relatively good condition throughout. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 18 Of the forty-one rooms, twenty-five bedrooms are slightly under the 10 square metres minimum – with only one much smaller room (8.6sq.m.) – which is registered and designated to be solely occupied by short-term / emergency / respite admissions to the home. The home provides one assisted bath in each of the six units; there is also an additional single shower facility in the home, which, currently, has very little use. A ground floor accessible toilet has now been created 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 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 those using hearing aids. All external stairways are provided with railings to ensure the home meets the Disability Discrimination Act assessment recently undertaken. The emergency call bell system is antiquated; staff members have to move to a unit indicated by light signals and then search out a light shining outside a bedroom or other area. The alarm alert is by an invasive universal noise, whereas most modern systems rely on subtle ‘bleepers’ carried by staff members that indicate the precise location of the call instantly. The passenger lift, the inspector was told, is frequently ‘playing up’ – the manager, on touring the home with the inspector, had to manually push the door open when it jammed halfway open (leaving the inspector anxious that they might get stuck in the lift). On previous visits in the evening –the noise emanating from the lift as it travelled was most disturbing to service users in their rooms – even some distance from the actual lift shaft. A replacement is clearly urgently required – especially if the ‘go ahead’ is given to move the Bawtree service into the home – probably leading to a greater use of the lift. 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 days. The immediate outlook to the gardens is pleasant and it is no surprise to the inspector that the majority of service users spoken to expressed a wish to have the ground floor if they had to be moved to a certain ‘sector’ of the home on the advent of the Bawtree House service. The house was generally clean and odour-free at the time of the inspection; the inspector did note, however that the undersides of bathing hoists and the underside of non-slip rubber mats were allowed to become substantially scaled up in the former instance and mouldy in the latter. Such areas must be thoroughly and frequently cleaned and dried - to avoid any risk of build-up of scale / fungus which can be a source / hiding place of potential cross-infection. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 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. Training focused on the client groups accommodated at the home and their specific needs should be provided, where appropriate, to ensure an appropriate approach to service users at all times. The registered provider supports the home through its recruitment and employment procedures and practices to ensure that equal opportunities are promoted and that service users are protected from potentially abusive staff. EVIDENCE: Staffing is provided at the home with a minimum of seven care staff and a senior on duty in the mornings, six care staff and a senior in the afternoons, with two care staff and a senior asleep, but on call on site, at nights. Relatives opinion was ‘split’ as to whether there was sufficient staffing; one was concerned that there were insufficient staff to accompany service users to hospital – leaving relatives / family to this task. Four care assistant posts are due to be imminently recruited to; the closing date for applications [following a successful Jobs Fair] was the second day of Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 20 the inspection. It was understood from the manager that about 25 of care staffing posts are being held vacant to accommodate staff potentially joining the home from the closing Bawtree House. Agency staff are employed to cover staff sickness / annual leave and training absences. Staff members expressed a concern that there would be too many staff members at the home if the Bawtree House move actually takes place; clearly most staff are very settled – and ‘part of the furniture’ themselves at the home. Only three staff members had left Ludlow in the past year – one retiring, one moving to another job and one, sadly, passing away. Relatives commented about the service: ‘very impressed by staff stability and care.’ Staff members were indeed very much appreciated also by service users: ‘They’re real friends once you get to know each other’ stated one interviewee. The home is well on track to achieve its 50 figure for care staff trained to NVQ Level 2; at the time of the inspection, seventeen care staff were noted to either have exceeded, achieved, or be in the process of undertaking their NVQs. The manager stated that the goal was to get every staff member enrolled on, at least, the basic course. Staff member training records were seen and were both comprehensive and systematic. The Borough offers a wide range of training opportunities and mandatory Fire Training was next on the list for all staff to be involved in. The inspector has already touched on an incident of inappropriate behaviour towards a service user by a member of staff, and reiterates - in a second requirement - the need to ensure that staff are appropriately trained in understanding, working with, and communicating with older people - especially those with dementia / other disabilities. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 - 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, though the information provided to those with monies held in safekeeping by the Borough could be improved to provide more information to those service users. Staff members receive appropriate supervision and this process ensures a focus on the area of staff development and appropriate training needs – thus enhancing the overall service. The registered provider, through a process of updating policies and procedures, seeks to ensure that best practice is adopted, based on this new Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 22 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. EVIDENCE: The manager, Richard Low, oversees the entire service at Ludlow Lodge – including the day care service - which is managed on a day-to-day basis by one of the senior staff. Mr Low a registered Mental Health Nurse, 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, with senior carer staff managing the units and associated teams of staff. Medication, Staff training and Activities & outings are designated areas held in additional responsibility – one each to each senior carer. The home has its own quality assurance surveys in place concerning activities and meals – the manager finds that a single focus elicits a better response than a generic questionnaire. Another focus on quality assurance relies on the registered provider having a clear supervisory and critical input into the home’s performance; and all providers, or a nominated representative, are required - by regulation - to make monthly unannounced visits to the home and to prepare a report on the conduct of the home for the benefit of the home, the Commission and the registered provider themselves. This has not been happening in a formally structured way – though the service manager has clearly been visiting the home on a regular basis. The inspector was assured that an ‘independent person’ will be conducting these visits on behalf of the registered provider. The financial interests of service users are safeguarded by the home in general terms; the accounting of monies at the home held in safekeeping and local administration processes were examined and found well maintained. Service users sign individual receipts to receive monies paid as personal allowance; ensuring that suitable privacy and dignity is given to this process. Seven service users have their affairs managed by the by the Council’s Client Officer. The inspector questions how any deposited sums which are held in safekeeping by the Borough are invested - and to what extent service users are informed about the sums held, and how notified of interest awarded on those sums. Records of staff supervision were seen, evidencing that they are conducted within the minimum standard timescale required. Health & safety / maintenance records for the home were all in good order. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 1 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 3 3 2 3 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 3 2 3 3 3 Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 24 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 03 Regulation 14 Requirement Full assessments must be obtained / carried out by staff or care management prior to the admission of a service user to the home. Without such information staff have to provide a service based on intuition / word of mouth. Placements must not be made at the home on a permanent basis into the undersized bedroom reserved for short-term respite care, neither must out-ofcategory placements be made in the home - without the express agreement of the Commission, this being attached to the granting of a Variation to the homes registration. Care Plans must be put in place on day one of any placement at the home - based on the information either provided by the Care Management Comprehensive Assessment or by the homes own assessment of the prospective service users need. G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Timescale for action 30.06.05 2. 04 14(1) 30.06.05 3. 07 15 30.09.05 Ludlow Lodge Care Centre Version 1.30 Page 25 4. 09 13(2) Medicine cupboard keys must be kept on the person of the designated holder or secured away - not slipped into kitchen drawers for others to possibly find. Personal care items - including prescribed creams - must always be used for that person in particular ONLY; items must be marked with an identifying name if they are to be moved from an individuals room, and the item immediately returnd to their bedroom after use. 01.07.05 5. 10 12(4) 01.07.05 6. 11 15 Detailed information concerning 30.09.05 service user’s (or relative’s) wishes about steps to be taken should they be taken suddenly seriously ill, or pass away, must be elicited from the individual and recorded confidentially on the care plan (11). (Timescale of 30.08.04 not met.) Approaches to service users must be made in the light of professional understanding of a service user and their circumstances, and with a view to preserving their dignity and self-respect. 01.07.05 7. 12 12(4) 8. 19 13(3) Attention must be paid to 01.07.05 ensuring thatr bathroom areas are left scrupulously clean especially in areas such as hoists and non-slip mats. etc - to ensure the absolute minimisation of any possibility of crossinfection. The passenger lift within the home must be reviewed for fitness and a replacement urgently considered; the noise 30.10.05 9. 22 23(2) (b) (c) Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 26 incurred by the current mechanism is very disturbing and intrusive for service users in the home (19.2). 10. 26 23(2)(n) The call bell provision within the home must be changed to ensure that all points of call are cancellable only from the source of the call, and to address the need to remove the intrusive noise throughout the home; a hand-held ‘bleep’ system must be introduced (22). (Timescale of 30.08.04 & 30.07.05 not met) Staff members - where necessary - must be trained in understanding and communicating with older people and those with dementia. Reports of the visits of the representative of the registered provider must be made on a monthly basis, copied to the Commission and kept on site for inspection (33). (Timescale of 30.08.04 and 01.07.05 not met.) The long-term safekeeping of monies on behalf of service users must be provided alongside regular statements of sums held and statements concerning the awards of regular interest accrued by those sums. 30.10.05 11. 30 18(1)(c) 30.10.05 12. 33 26 & 17(2) 30.09.05 13. 35 20 30.10.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 27 Ludlow Lodge Care Centre 1. Standard 3/4 That a familiarisation profile - to elicit the more informal / soft aspects of a service users lifestyle and preferences should be introduced, to ensure that such information is available for all staff to provide a focused service at the point of arrival and immediately thereafter, without having to ask again and again. Ludlow Lodge Care Centre G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 28 Commission for Social Care Inspection 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 G53-G53 S38481 ludlowlodge V192317 300605 stage 4.doc Version 1.30 Page 29 - 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!