Inspection on 17/01/06 for Madeira Lodge

This inspection was carried out on 17th January 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

Madeira Lodge 13/07/06

Madeira Lodge 28/06/05

Madeira Lodge 27/10/04

Madeira Lodge 17/06/04

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

CARE HOMES FOR OLDER PEOPLE Madeira Lodge Madeira Road Littlestone New Romney Kent TN28 8QT Lead Inspector Wendy Mills Unannounced Inspection 17th January 2006 10:00 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 Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Madeira Lodge Address Madeira Road Littlestone New Romney Kent TN28 8QT 01797 363242 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) Belmont Sandbanks Ltd Vacant Care Home 28 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (27) of places Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. MD restricted to one person DOB 11/7/38 Resident with DE (E) is restricted to one person whose DOB is 12/03/1939. Residents under 65 years of age are restricted to one whose date of birth is 16/08/1942. 28th June 2005 Date of last inspection Brief Description of the Service: Madeira Lodge is a residential home providing care for up to twentyeight older people with failing mental capacity. Belmont Sandbanks, the registered providers, own another residential care Home nearby. Ms Rachel Daykin has recently taken up the post of manager. She is currently preparing her application for registration with the Commission for Social Care Inspection (CSCI). The Home is located a mile from the small town of New Romney and within easy walking distance of the sea. Accommodation is provided on two floors with a shaft lift connecting the two floors. There are twenty six single rooms, three of which have ensuite facilities and two shared rooms. There is a choice of sitting areas on the ground floor and residents have access to an enclosed garden with seating to the rear of the premises. The garden is currently being altered to provide a sensory garden with raised flower beds. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection began at 10.00 and lasted four and a half hours. The manager of the home, Ms Rachel Daykin, assisted during the first part of the inspection. The registered provider, Mr Keith Hutchinson, was also present for some of the time and Ms Caroline Read, the deputy manager, assisted during the latter part of the inspection. The inspector was able to speak in private to two residents and two members of staff. In addition, she had contact with two relatives prior to the inspection. She also spoke to several other residents in the main communal areas on the day of inspection. Key documentation, including care plans, was examined and a tour of the home undertaken. Both indirect and direct observations were made throughout. The management team, the staff and the residents are thanked for their assistance during this inspection. What the service does well: What has improved since the last inspection? The medication policies and procedures have been reviewed and re-written to ensure that the administration of medicines is as safe as possible. Relationships with local GPs and other healthcare professionals have improved. Guidelines have been introduced to help staff know when it is appropriate to call on medical advice. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 6 The activities in the home have again improved. Space has been set aside for quiet activities and the home is more diligent in recording the activities that have taken place. Recruitment procedures have been tightened. All staff have been appraised and job descriptions are currently being reviewed. Staffing levels and staff training have improved. Organisational structures have been changed so as to give clearer lines of responsibility. The manager’s office has been tidied and is now much better organised. New commodes have been purchased and a great deal of disused and damaged equipment and furnishings have been removed from the home. Some individual tables have been removed from the lounge and this has reduced the number of falls in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 The statement of purpose and the service user guide are good. They provide the residents and prospective residents and their supporters with the information they need to make a decision about moving into the home. The assessment and admissions procedures are sound. EVIDENCE: Previous inspections have shown that the statement of purpose for the home is comprehensive and that the service user guide gives clear information about the home. The statement of purpose has been amended to reflect the recent changes in organisational structures. There are sound policies and procedures for assessment and admission to the home that include pre-admission assessment and trial periods. Inspection of recently admitted residents showed that appropriate pre-admission assessments have been made. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 There is a consistent care planning process that provides the staff with the information they need to care for the residents. The home safeguards the privacy and dignity of the residents very well. EVIDENCE: Care plans have been reviewed and are now in a clearer format, which is much easier for staff to understand. Staff spoke very positively about the change and said that they are now much clearer about the needs of the residents. The care plans are up-to-date and in good order and the specific needs of the residents are recorded. Health care professionals are contacted appropriately and their advice sought. There has been improvement in the way that the home communicates with GPs and other healthcare professionals. There are now specific days allocated for GPs to call and review the residents and guidelines for staff have been introduced to ensure that healthcare professionals are called in appropriately. All the residents were in good health on the day of inspection. Conversation with care staff confirmed that they are able to meet the needs of the residents. Staff were observed to interact appropriately with the residents and one Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 10 resident said he enjoys friendly banter with the staff. Indirect observation confirmed that the staff treat the residents with respect, dignity and a great deal of kindness. Since the last inspection the policies for the management of medicines have been reviewed and re-written. This should ensure that the administration of medicines in the home is as safe as possible. A member of staff has been given the responsibility for overseeing the ordering and disposal of medicines. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 & 15 The home makes every effort to ensure that the residents are able to enjoy an interesting and fulfilling lifestyle. It helps the residents make appropriate choices when indicated. The home recognises the importance of good nutritional management and caters for special diets. EVIDENCE: The home employs an activities organiser who works both directly with the residents. Staff members are encouraged to help the residents participate in interesting activities. Since the last inspection, a quiet area of the home has been designated, during certain times, for group activities. More care has been taken to record the activities in which residents have participated and the particular activities that they enjoy. Life histories and likes and dislikes are recorded in the care plans. Staff were observed to offer choice in a way that was appropriate to each resident’s understanding. There is a choice of menu and the food and there are plentiful supplies of nutritious produce. Both fresh meat and fresh fruit and vegetables are purchased locally. The home is now better at monitoring food intake. Weight Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 12 is monitored regularly but this could be improved by monitoring goal weights, reasons for monitoring and action taken or to be taken. In order to ensure that the residents have adequate nutrition, menus have been reviewed to ensure that the food is both appetising and easy to eat and snacks are encouraged outside of mealtimes especially for those residents who find it difficult to eat sufficient food at regular mealtimes. It was good to note that several residents had put on an appropriate amount of weight since the last inspection. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has a satisfactory complaints procedure with evidence that the views of the residents and/or their relatives are taken into account and acted upon. The staff have a very good awareness of Adult Protection issues. This protects the residents from abuse. EVIDENCE: There is a satisfactory written complaints procedure. Staff are aware of their responsibility to complain on behalf of residents who are unable to speak for themselves. Staff said that Ms Daykin has improved communication in the home and that they feel very comfortable in talking to her. They said that she often works alongside them. This means that she has a very good awareness of the residents concerns. Staff have received adult protection training and have a good awareness of the whistle-blowing procedures. Staff said that they would be prepared to use the whistle-blowing procedure should the need ever arise. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 & 26 The standard of décor is good and there is continuous monitoring and improvement of the environment of the home. Overall there is a comfortable and homely environment for the residents and their visitors. Health and safety measures in the home are generally good. The home is clean and pleasant and infection control measures have improved. EVIDENCE: The home was clean and mostly free from offensive odours on the day of inspection. Bedrooms are comfortably furnished and homely. Several residents have chosen to bring items of furniture from their own homes. The bedrooms reflect the individuality of each resident. There are sound health and safety policies and procedures. Several health and safety improvements have been made since the last inspection. A great deal of worn furniture and disused equipment has been removed from the home. Small tables in the lounge have been removed and this has reduced the risk of falls. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 The staff have a good understanding of the needs of the residents. This is evident from the positive relationships between staff and residents. Staff morale has improved since the last inspection. Recruitment practices are sound and the level of staff training has improved. EVIDENCE: Recruitment procedures have been tightened and the hoe is curre3ntly reviewing all staff files. The level of staff training has improved since the last inspection. There has been recent training includes manual handling, POVA, health and safety and dementia. A training adviser has been employed to progress staff training in specialist area. All staff have now been appraised and clearer job descriptions are being introduced. This will mean that staff have a better understanding of their roles and responsibilities. Staff said that they had noticed a significant improvement in the home since the new manager took up her post. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 16 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, 32, 33, 36, 37 & 38 The home is well managed and there is clear leadership throughout the home. The views of the residents and their supporters are listened to and acted upon. EVIDENCE: Ms Daykin has recently been appointed as manager for the home. She is currently preparing her application for registration with the CSCI. Ms Daykin is a registered mental health nurse who has maintained her registration with the NMC and her continuous professional development. She has over ten years experience as a mental health nurse, working in both hospital and community settings. Discussion with Ms Daykin showed that she has excellent knowledge and understanding of the needs of the residents. She communicates well with the residents, their supporters, staff and other healthcare professionals who visit the home. The staff were very positive about the changes that Ms Daykin has made since taking up her post. They said that they find her very easy to talk to and respect her for the time she spends working alongside them. Since Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 17 taking up her post, Ms Daykin has communicated well with the CSCI and kept us informed of any issues that might influence the lives of the residents. She is open and honest in her approach and is well supported by the registered provider, Mr Hutchinson and her senior staff. Since the last inspection the office has been tidied and a great deal of documentation has been reviewed. All documents requested during the inspection were to hand, up-to-date and in good order. All staff have received recent appraisals and there is an organisational structure that will allow for adequate one-to-one supervision. However, a system for staff supervision now needs to be established so as to ensure that all staff receive at least six one-to-one supervisions each year. The registered provider, Mr Hutchinson, is available in the home on four days each week. He demonstrates a willingness to work with the CSCI and has a clear vision for the improvements he wants to make in the home over the next two years. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X 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 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 3 3 Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 19 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 OP36 Regulation 18 Requirement A system of regular one-to-one supervision to be established. Timescale for action 01/04/06 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 15 Good Practice Recommendations The home should improve the way in which it records weight by including reasons for checking weight, goal weight and action taken, or to be taken, should there be a significant weight loss or gain. Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Madeira Lodge DS0000023467.V277822.R01.S.doc Version 5.1 Page 21 - 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!