CARE HOMES FOR OLDER PEOPLE
Natal Lodge 19 Natal Road Thornton Heath Croydon Surrey CR7 8QH Lead Inspector
Claire Taylor Unannounced Inspection 22nd September 2005 1:00 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 Natal Lodge DS0000025816.V255304.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. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Natal Lodge Address 19 Natal Road Thornton Heath Croydon Surrey CR7 8QH 020 8771 4595 020 8251 2785 vijayen@hotmail.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Goinsamy Anenden Mrs Jayamane Anenden Mrs Jayamane Anenden Care Home 3 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (0) of places Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow one specified service user under the age of 65 to be accommodated subject to: (1) a minimum annual review of the service user`s health needs (2) staff continuing to have the necessary skills and training to meet the service user`s needs (3) alternative arrangements being sought should the home no longer be able to meet the service user`s assessed needs. 17th February 2005 Date of last inspection Brief Description of the Service: Mr & Mrs Anenden own Natal Lodge and also work in the home. It is registered with the Commission for Social Care Inspection to provide care and accommodation for three elderly service users with mental health needs. A variation has also been granted for one service user to live there who is under the age of 65 years. The home is a residential terraced house situated in Thornton Heath, approximately 10 to15 minutes walk from the main town centre. The home is well placed to access local transport links and amenities. All service users have the benefit of a single room and plenty of communal space that includes a lounge, dining area, conservatory room and pleasant garden. There is also a well-equipped kitchen and separate laundry facilities in the conservatory area. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was unannounced and took place over one afternoon lasting two and a half hours. All three residents were out at the time of the inspection. Although residents were not available to give their views in person, they had completed pre inspection comment cards and feedback was positive about the home and their lifestyles. Likewise, relatives also completed a questionnaire about the home and gave complimentary views. The Commission welcomes their comments as a valuable contribution to the inspection process. Inspection time was spent talking to the owners, Mr and Mrs Anenden and included a brief tour of the premises and a check on various records related to the residents and the operation of the home. The registered providers are thanked for their time and assistance. What the service does well:
Due to the home’s small size and family run atmosphere, residents benefit from close support provided by a well-established staff team. As at the last inspection, the home continues to be well managed with good standards of care practice maintained. Planning and review of care is thorough and shows that the home is able to meet the residents’ needs. Care plans are detailed, highlight achievements and progress and are reviewed and revised regularly or as individual needs change. Activities have been arranged to suit the needs of the residents and provide interest and stimulation both within the home and out in the local community. Systems are in place for supporting residents to exercise choice and control over their lives. Staff have a variety of skills and knowledge relevant to the setting and residents needs are well understood. The premises were once again in very good decorative order and clean and tidy. Relatives gave feedback that they were satisfied with the care being provided to their family member. One remarked, “ I am very happy with the care my brother receives. Mr and Mrs Anenden are to be congratulated on the first class home they run.” Good evidence was available that the owners demonstrate a commitment towards maintaining and improving standards of care as well as compliance with the National Minimum Standards and regulations. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Natal Lodge DS0000025816.V255304.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 Natal Lodge DS0000025816.V255304.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): 4 Standard 6 is not applicable to this home as it does not provide intermediate care. A comprehensive assessment is undertaken prior to admission to ensure that the home can meet the assessed needs of all service users. EVIDENCE: There have been no new admissions to Natal Lodge since the last inspection. Residents files were examined and in very good order. Each individual has an up to date needs assessment. The assessment includes general information about the person, details of their background, medical and social history and comprehensive details of specific areas such as nutrition, skin care, medication and mobility. These clearly show that the individual needs of each resident had been identified. Natal Lodge DS0000025816.V255304.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): 7, 8 and 9 Residents are treated with dignity and respect. The residents care and health needs are identified and reviewed regularly so that they continue to be met and they are able to access care from additional healthcare services. Medication is well managed to maximise each individual resident’s health. EVIDENCE: Files demonstrate that all three residents have a comprehensive plan of care. There was evidence from review notes that their care needs are being regularly reviewed with amendments being made where needs have changed. One plan showed that the newest resident has made significant progress in building confidence since moving to Natal Lodge a year ago. The person now accesses the community more often and has developed their social skills further. The residents are very much involved with their care plans and sign in agreement with their key staff at the monthly review. Psychological needs are reviewed regularly. Residents are in regular contact with a General Practitioner and other health care professionals as necessary including consultant psychiatrist, chiropodist, continence advisor and optician. The home keeps records of all healthcare appointments, in addition to individual daily progress notes and an accident book. Comprehensive risk plans are in place; they were up to date and provided a range of assessment relevant to the needs of older people, i.e.
Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 10 nutritional and mobility risk assessments including the prevention of falls. No resident is able to take their medication independently at present but would be supported to do so if they so wished. Each resident has a written profile to specify what medication is required. Medication records checked, including medicines received, administered and returned were accurate and all being maintained to a good standard. One resident’s diabetic condition is well managed and both the registered providers and one senior staff have received suitable training to administer insulin. Regular blood sugar checks were being maintained. As previously recommended, the home has developed a homely remedies policy which has been approved by the G.P. Domestic medication such as painkillers is now available for residents should they need it. Natal Lodge DS0000025816.V255304.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): 12,13,14 and 15 Residents are being provided with a range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. Contact with family and friends is facilitated and links with the local community are encouraged. Residents are consulted about meals, activities and other aspects of daily living and therefore differing expectations and lifestyles are well catered for. Meals are wholesome, appealing and the diet is nutritious. EVIDENCE: A variety of recreational activities are available within the home including gentle exercise sessions, books/ magazines, games, music system, television and weekly shopping trips. The home has a notice board for displaying information about local events and activities that may be of interest to the residents. Records showed that residents are encouraged to be involved in the local community such as going to the local pubs, cafes and to attend their chosen place of worship. One resident travels independently on public transport and the others are supported by staff to access their chosen activities. Family and friends are invited to any social events held at the home as well as review meetings. Meals are provided at flexible times with drinks and snacks available upon request. Records are kept of food provided for the residents and they are consulted about their food preferences. Dietary needs are clearly recorded in the individual’s care plan and one resident ‘s diabetic condition is catered for. Menus are varied and nutritionally balanced. It is
Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 12 suggested that the menus are now rewritten to reflect the cultural preferences for one resident. The registered provider agreed to address this, as the menus were somewhat outdated. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 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 and 18 Arrangements for complaints and protection from abuse are well managed and ensure that residents feel listened to and safe. EVIDENCE: The home’s complaints procedure contains all of the relevant and necessary information and is readily available to the people who live there, their relatives and other visitors. Information is made available in large print and defines clear guidance on how to make a complaint. A book is kept in the home to log complaints and concerns; there have been no complaints since the last inspection. Recruitment policies ensure that staff are properly inducted and have an understanding of the prevention of abuse and what action to take if they suspect anything untoward. The London Borough of Croydon’s adult protection procedures were also available in the home. Relevant CRB police checks were verified for all staff at this inspection. Mr and Mrs Anenden and one senior staff have all attended formal training in adult protection. It would be good practice if this training were extended to the owners’ two daughters who also work in the home. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 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 and 26 The residents live in a well-maintained, clean and comfortable environment and have access to safe and comfortable facilities. EVIDENCE: The home is located on a residential street in Thornton Heath. Local shops and public transport are within easy reach of the home. The premises are decorated to a high standard and furniture and fittings were of good quality, safe and well maintained. The bedrooms were not viewed on this occasion, as none of the residents were available. As required at the last inspection, a fire safety inspection has been carried out by the London fire and emergency planning authority. The registered provider had addressed all of the requirements set including provision of suitable fire door closures and a fire risk assessment. Good standards of hygiene practice are well observed and the home appeared clean and free from odour. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 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 and 30 There is a competent and well-trained staff team who clearly understand the needs of the elderly people living there. On the whole, recruitment practices are securely managed to maximise protection for the residents although all appropriate checks must be obtained for staff before they start work. EVIDENCE: Both the proprietors, Mr and Mrs. Anenden live and work in the home. Their two daughters also work there plus one senior trained staff. The small staff team provide twenty-four hour staffing in a family type setting. Most requirements identified at the last inspection have been addressed including the provision of a day-to-day staff rota, a suitable induction pack and contract of employment for all staff. The registered manager has also compiled personal files for her two daughters that now include all the necessary documentation required by the care homes regulations. In addition, staff training has progressed and the owners’ daughters have attended some further courses to keep their knowledge and skills up to date. Such information shows that staff are fit to work in the home and have been provided with appropriate guidance to do their jobs properly and meet the residents needs. The provider explained that the home accesses training through the National Care Homes Organisation who send out a list of courses on a quarterly basis. A flyer was available in the home to reflect this. Mr and Mrs Anenden’s daughters still need to attend training that is specific to the needs of the residents including mental health awareness and diabetes. It is acknowledged however that there are plans for them to access suitable courses as and when they become available. Records
Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 16 showed however that the owners’ daughters had completed a full orientation to the home and been given guidance on meeting the residents needs. Since the last inspection, the owner has recruited a part time cleaner who works for two hours, four days a week. Unfortunately, no CRB or POVA check was available for the new employee and the registered provider must ensure that staff are vetted correctly before they commence duties. Rotas confirmed however that the staff concerned was not working unsupervised and this must continue until the owner is in receipt of an approved CRB/ POVA check. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,36 and 38 Based on residents’ views, the home has good systems in place to show how they intend to make positive changes and monitor quality of care. Staff benefit from close supervision and guidance from management although discussions should be recorded. The residents’ financial interests are being safeguarded and health and safety practices in the home are well managed to ensure that the welfare of residents and staff is promoted and protected. EVIDENCE: A range of quality assurance systems are used to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include care plan reviews, meetings, monthly rotational audits of care plans, risk assessments and the environment. Due to the small size of this home, daily discussions with residents regularly take place as well as formal monthly meetings to seek their views about the running of the home. A ‘residents satisfaction survey’ is offered on an annual basis and had been completed in July of this year. Feedback indicated highly complimentary views
Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 18 about the home and the care provided. Questionnaires are also offered to residents’ family members and other professionals. Again, positive feedback was noted from a community psychiatric nurse and one relative. As previously required, the home has implemented an annual quality development plan. Two residents handle their own affairs and keep their own purse / wallet of personal monies. The provider is appointee for the third resident and as suggested at the last inspection, he has written to the placing authority to request that they take up appointeeship. Croydon wrote back and stated that they were in the process of reviewing their financial procedures concerning appointeeship so it is envisaged that this will be dealt with at a later date. Residents are issued their weekly personal allowance and sign to confirm that they have received this. Records confirmed that an accurate financial monitoring system is in place and that transactions as well as correspondence relating to financial affairs are well managed. It is acknowledged that this service is a small home and staff supervision is mostly informal and undertaken by the registered manager or provider on a day-to-day basis to discuss concerns, monitor job performance and offer guidance. The manager had undertaken a yearly appraisal with one staff and plans to complete the others. As required previously, formal records of supervision for all staff still need to be maintained however to fully meet the standard. Record keeping concerning health and safety is in good order. Staff were fully up to date in key areas of health and safety training i.e. moving and handling, food hygiene and first aid. Accurate records are kept for accident and incident reporting. Fire drills, fire equipment and hot water temperature checks were being carried out at appropriate intervals and cleaning products are stored safely. Informative risk assessments for the premises have been put in place since the last inspection that further safeguards the health, safety and welfare for all those living and working in Natal Lodge. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 2 X 3 Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 17(2) 9(1)(b,c) Requirement Timescale for action 31/10/05 2. OP36 18(1a)(2) The registered provider must ensure that they obtain an up to date CRB and POVA check for new staff before they commence employment. Staff must continue not to work unsupervised until such time that a valid CRB and POVA clearance has been obtained. The registered provider must 30/11/05 ensure that each member of staff has formal documented supervision at least six times per year. (Timescale from previous two inspections not met) Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP15 OP18 OP30 OP30 Good Practice Recommendations That the menus are now rewritten to reflect the cultural preferences for one resident. The owners’ two daughters who work in the home should attend formal training on adult protection. That the home’s annual training and development programme is documented. Further training for two staff is recommended that is specific to the needs of the service users. i.e. to develop a better understanding of mental health awareness and diabetes. Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Natal Lodge DS0000025816.V255304.R01.S.doc Version 5.0 Page 23 - 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!
