This inspection was carried out on 10th October 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.
CARE HOMES FOR OLDER PEOPLE
Minchenden Lodge Blagdens Lane Southgate London N14 6DD Lead Inspector
Tony Brennan Unannounced Inspection 10th October 2005 11:00 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 Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 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. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Minchenden Lodge Address Blagdens Lane Southgate London N14 6DD 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) 020 8886 1222 020 8886 1222 Scimitar Care Hotels Plc Ms Maria A Simpkins Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd August 2005 Brief Description of the Service: Scimitar Care Hotels PLC owns Minchenden Lodge. The company owns a number of other homes in the North London area. Minchenden Lodge is a long established home in a residential part of Southgate. There is easy access to public transport and shops. The home now has twenty-one single rooms and no longer has double rooms. The home is registered to care for twenty-five older people but this is no longer relevant given the new changes to the double rooms. The home aims to provide personal care only for older people. The aim of the home is to deliver good quality care in comfortable surroundings ensuring that service users needs are met as individually as possible. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the ten areas for improvement found at the last inspection were addressed. The inspection took place over one day. The registered manager, Maria Simkins, assisted the inspector. The inspector spoke with six service users and three staff. The inspector observed practice. The inspector toured the building and examined a range of records relating to the care and management of the home. What the service does well: What has improved since the last inspection? What they could do better:
There are twenty areas for improvement identified as part of this inspection. People who had recently come to live at the home were not assessed and did not have care plans detailing the actions to meet all their needs. Care plans had not been agreed with those living at the home or their representatives. The personal preferences of those who live at the home were not recorded. Those who live at the home who are susceptible to developing pressure sores had not had assessments and measures to prevent this were not recorded as part of their care plans. Care plans did not provide detailed information on how to support those who live at the home. This meant that their needs were not always being met. The weight gain or loss of people who live at the home was not recorded with the result that changes in their physical health was not monitored. People who live at the home told the inspector that they had falls and were susceptible to falling. There were no assessments of individual’s risk of falls or planning to prevent falls. Not all medicines received into the home were recorded with the result that it was not possible to ensure that those who live at the home were receiving all the medication they had been prescribed.
Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 6 Training was found to be needed on medication administration, adult protection, first aid, infection control and the use of fire extinguishers to ensure that people living in the home are safe and receive the care they need. Checks were not carried out on new staff to ensure that they were suitable to work with vulnerable people. Staff were not supervised regularly to ensure that they were supported to provided the care and support that those living at the home needed. Fire drills need to be carried out at night to ensure the safety of those living at the home. The fire risk assessment and evacuation procedure needs to be reviewed to ensure that all risk of fire is assessed and appropriate action will be taken in the event of fire to protect those living at the home. The automatic door close for bedroom No. 20 needs to be replaced as it does not work and poses a risk to the people who live at the home in the event of a fire. 50 of staff need to achieve NVQ in care to ensure that staff have the skills to meet the needs of those living at the home. 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. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 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 Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 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): 34 Service users needs are not assessed prior to admission to the home. The home does not meet all of the assessed needs of service users. EVIDENCE: The inspector spoke with three service users recently admitted to the home who were generally happy with the care provided. Two service users explained that they had hearing and sight needs and they felt these were not sufficiently understood by the home’s staff. The inspector found that there had not been an assessment of these needs prior to admission. Other areas of need had been assessed. The five service users who had been admitted recently had no care plans and it was not possible to see how their needs were being met. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 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): 789 Service users have insufficient information on how their needs are met. Service users risks of falls were not assessed and there was no plan for their prevention. Service users medical needs were not being met. Service users are not protected by safe procedures for handling medication. EVIDENCE: The inspector found that five service users admitted over the last six months had no care plans. There was no information on their needs and what actions were required to meet them. Service users spoken to said that they had not been consulted about their care needs and personal preferences. One service user spoken to told the inspector that they had falls prior to and since being admitted to the home. The initial assessments of three of the service users recently admitted highlighted a history falls as being a factor in their need for admission to the home. The Accident Record showed that there had been five falls in September. This was discussed with the registered manager who agreed to address these issues. The records of medical interventions showed that service users had access to appropriate medical treatment. For example, blood tests had been carried out and follow up treatment had been arranged. There was still a need to assess and plan for the prevention of pressure sores. Service users weight still was not being measured.
Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 10 The registered manager explained that since the last inspection the home had changed to a monitored dose system for the administration of medicines. The records of medicines administered by the home and returned to the pharmacist were complete. Not all medicines received by the home had been recorded. The registered manager explained that staff had been trained by senior staff at the home in the administration of medication. The registered manager explained that this had been done to ensure that enough staff are available to administer medicines. All staff that administered medicines must receive training from a pharmacist in the safe administration of medicines. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 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 Service users had not been consulted about their personal preferences as to how they wished to live. Service users were not provided with sufficient and varied social and cultural activities. Service users are provided with varied and balanced meals. Meals need to be provided that meet the cultural preferences of service users. EVIDENCE: Care plans still did not provide information on service users preference about how they wished to live. Three relatives commented that not enough activities were provided. On the day of the inspection no activities took place. This was discussed with the registered manager who explained that activities were usually provided in the afternoon, but that there was not a programme for this. Service users commented that the food was good and choices were provided. The menu showed that varied and balanced meals were offered. Service users said they were consulted daily about the choices being offered. The inspector saw that meals were well presented and they were provided in a relaxed environment. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 12 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 are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse, but staff need training in this area. EVIDENCE: Service users said that they felt confident in making their concerns known to staff. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. Service users said that they felt safe and could approach staff if they had any concerns regarding how they were treated. There were comprehensive policies on handling abuse and protection. Staff spoken to were clear about the signs of abuse and how suspected abuse should be handled. Training records showed that staff had not received training in adult protection. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 13 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 26 The home provides a safe and well-maintained environment for service users. The home is hygienic and clean. EVIDENCE: The inspector found that the home was adapted to meet the needs of service users. There were assisted baths and toilets provided. Service users were able to access all parts of the building by the lift. The inspector found that the home was clean and hygienic. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Sufficient staff are available at all times to meet service users needs. Staff do not have the skills to meet all the needs of service users. Service users are not protected by the home’s recruitment practices. EVIDENCE: Service users spoken to felt that generally there were sufficient staff. The rota showed that staffing levels were maintained consistently with four care staff working in the morning and three in the afternoon. The inspector examined three staff files for staff recently employed at the home. These did not contain all the POVA first or CRB checks. Service users spoken to said that staff understood and had the required skills to meet their needs. The inspector spoke with staff and found that they understood and knew how to meet the needs of service users. Training records showed that training on first aid and infection control is needed. The registered manager explained that six staff had started the NVQ in care at level 2 and three had completed the qualification. The home still needs to ensure that 50 of staff have the NVQ in care. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 15 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): 36 38 Staff are not appropriately supervised. Service users and staff health and safety is not promoted at all times. EVIDENCE: The registered manager explained that supervision had not taken place. This was due to the pressure of managing the home. The inspector discussed this with the registered manager who agreed to ensure that staff receive supervision. The fire prevention equipment had been maintained. There were records to confirm testing of the alarms and emergency lights. Fire drills had taken place in the daytime. Fire drills had not taken place at night to ensure that night staff understood what to do in the event of a fire. The evacuation procedure and fire risk assessment needs to be reviewed and updated, as it did not give sufficient information to staff on how to respond in the event of a fire. Staff spoken to do not understand how to operate the fire extinguishers and the need for training on this was discussed with the registered manager. The
Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 16 inspector found the fireguard on the door of bedroom No. 20 did not work. The water temperature was tested weekly and records showed these to be within safe limits. The hoists had been checked and all first aid boxes had all the necessary items. The necessary records of food temperatures and of the fridge and freezers had been maintained. Gas and electrical certificates were seen and in date. The home had all the necessary policies and procedures in place to ensure the safety of service users and staff. There was a record of accidents in place. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 1 Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 18 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14 Requirement The registered persons must ensure that a detailed assessment of all the needs of service users is carried out prior to admission. The registered persons must ensure that all the assessed needs of service users are met. Timescale for action 01/01/06 2 OP4 14 15 01/01/06 3 14 15(1) 01/01/06 The registered persons must ensure that there are up to date risk assessments. The registered person must also develop risk assessments to determine whether service users are at risk of developing pressure sores and that a care plan is put in place that outlines the actions to be taken to maintain tissue viability. (Timescale 31/3/05 not met) The registered person must 01/01/06 ensure that the service users plans are detailed and personalised to ensure that their choices and preferences are reflected and can be met. These care plans must be signed and dated by service users or their
DS0000010661.V263497.R01.S.doc Version 5.0 Page 19 4 OP7 15(1) Minchenden Lodge representatives. (Timescale 31/3/05 not met) 5 OP7 15(1) The registered persons must ensure that all service users have care plans detailing their needs and the actions to them. The registered persons must ensure that service users wishes are respected. Service users must be asked what their preferred waking and bed times are and these must be respected. Service users must also be asked about their preferred breakfast times. This must be recorded in the care plan. (Timescale 31/3/05 not met) The registered person must ensure that the weight gain or loss of service users is taken and recorded on a periodic basis. Any action to manage weight gain or loss must be clearly recorded. (Timescale 31/3/05 not met) The registered persons must ensure that the risk of falls is assessed and a prevention care plan is in place for those service users at risk. The registered persons must ensure that all medicines received into the home are recorded. The registered persons must ensure that staff receive training in the safe handling of medicines from the home’s pharmacist. The registered persons must ensure that there is a programme of activities in place. The registered persons must ensure that training is provided on adult protection for all staff. The registered persons must ensure that all new staff have a POVA first check/CRB before
DS0000010661.V263497.R01.S.doc 01/01/06 6 OP7 15(1) 01/01/06 7 OP8 12(1) 01/01/06 8 OP8 14 15(1) 01/01/06 9 OP9 13(2) 01/01/06 10 OP9 13(2) 01/01/06 11 12 13 OP12 OP18 OP29 16(2)(n) 13(6) 18(1) 19(1)(b) 01/01/06 01/01/06 01/01/06 Minchenden Lodge Version 5.0 Page 20 14 OP30 18(1) 15 OP36 18(2) 16 OP38 23(4)(d) 17 18 OP38 OP38 23(4)(e) 23(4) 19 OP38 23(4) commencing work at the home. The registered persons must ensure that staff receive training on: First aid Infection control. The registered persons must ensure that staff receive supervision six times a year and this is recorded. The registered persons must ensure that staff have training in the operation of fire extinguishers. The registered persons must ensure that fire drills are held at night every three months. The registered persons must ensure that in consultation with the Fire Service, the fire risk assessment and the evacuation procedure are reviewed. The registered persons must ensure that the fireguard on the door of bedroom No. 20 is repaired or replaced. 01/01/06 01/01/06 01/01/06 01/01/06 01/01/06 01/01/06 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 OP28 Good Practice Recommendations The registered persons should ensure that 50 of staff achieve the NVQ at level two in care by 31/12/05. Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Minchenden Lodge DS0000010661.V263497.R01.S.doc Version 5.0 Page 22 - 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!
