CARE HOMES FOR OLDER PEOPLE
Natal Lodge 19 Natal Road Thornton Heath Croydon Surrey CR7 8QH Lead Inspector
Claire Taylor Unannounced Inspection 31 January 2006 3:00pm 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.V277389.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. Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 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.V277389.R01.S.doc Version 5.1 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. 22nd September 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 to 15 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.V277389.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was unannounced and the home’s second routine inspection for the year. This inspection therefore focused on the progress to meet requirements from the previous one and the core standards not assessed at that visit. There have been no significant changes in the home and the same three residents continue to live there. All residents were met during the course of the afternoon and gave their views about the home. Mr and Mrs Anenden, the homeowners facilitated the inspection and are also thanked for their time and assistance. What the service does well: What has improved since the last inspection? What they could do better:
Areas for improvement are centred round record keeping and training for staff. Although the manager had addressed the previous concern regarding recruitment of staff, further checks must be obtained for staff to maximise Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 Page 6 protection for the residents. I.e. two satisfactory job references sought as part of the documentation pertaining to all staff working in the home. Still to be addressed is that the manager must keep records to show how staff are supervised. I.e. records of discussions concerning meeting residents needs, overall job performance and career development needs. Two care staff still need to receive some further training that is relevant to the specific needs of the residents. As good practice, and repeated from the last inspection, the manager should develops an annual training and development programme for all the staff to show how training needs are identified and addressed. Aside from these issues, Natal Lodge continues to be a well run home and the manager and staff maintain high standards of care. 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.V277389.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 Natal Lodge DS0000025816.V277389.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): 3. Standard 6 is not applicable to this home as it does not provide intermediate care. The home has its own assessment tool to ensure that any new resident’s needs are fully assessed prior to their admission and that staff are aware of how to support them. EVIDENCE: There have been no new admissions to Natal Lodge since the last inspection. The manager has devised a pre-admission assessment tool for the home and assessments were completed appropriately for each resident when they all first moved to the home. Each individual also has a needs assessment undertaken by a care manager from the placing authority. The assessment tool includes holistic information about a person such as mobility, medical needs, social / cultural needs and dietary requirements. An individual care plan is then generated from the assessment which outlines the day-to-day care that is to be provided. Any prospective resident can therefore be confident that their needs would be fully assessed prior to admission. Natal Lodge DS0000025816.V277389.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 and 10 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. Residents spoken with were happy that they were treated with respect and that their privacy was respected as much as was possible. Standard 9 was assessed as met at the September 2005 inspection. EVIDENCE: Residents’ care plans are structured well and set out clearly how their needs should be met. The manager or staff regularly reviews each element of the plan. The residents are very much involved with their care plans and sign in agreement at the monthly review. Planning and review of care is thorough and therefore shows that the home continues to meet the residents’ assessed needs. Residents have access to the full range of community, and if necessary, specialist healthcare services with records of contact kept on their files. I.e. G.P., consultant psychiatrist, chiropodist and optician. Psychological needs are reviewed regularly and outcomes recorded within the care plans. For one resident, their plan has been developed in conjunction with the Care Programme Approach recommended for people with mental health needs.
Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 Page 10 Information relating to personal and healthcare needs including both routine and one off health interventions were well recorded. A good example of this was the records maintained in relation to one resident who was undergoing medical investigations via the local hospital. Residents are treated very much as individuals and their rights and needs respected and addressed. One resident had been referred to an advocacy service and the manager was awaiting a response. Any restrictions to individuals’ rights to ensure their wellbeing or safety were appropriately recorded within the care plans. In addition, comprehensive risk plans are in place that are relevant to the needs of older people, i.e. nutritional and mobility risk assessments including the prevention of falls. Natal Lodge DS0000025816.V277389.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 and 14 The home arranges a range of activities which provides stimulation and enhances the lives of its residents. Systems are in place for supporting residents to exercise choice and control over their lives. Standards 13 and 15 were assessed as met at the September 2005 inspection. EVIDENCE: There have been no significant changes to the residents’ lifestyles and all three individuals continue to follow their preferred interests and hobbies. Their personal preferences are recorded in the care plans. One resident travels independently to a local day centre during the week and confirmed that he enjoys going. Another resident said that he sometimes goes to a luncheon club. The third individual generally prefers to stay in the home aside from visiting the nearby shop for his daily newspaper or going shopping with staff. Recreational activities available within the home include television, radio, gentle exercise sessions, newspapers/ magazines, and board games. Residents went on an outing to London during the Christmas period. Information about activities and local social events.is displayed on a notice board. The owner and his wife encourage residents to exercise choice and control in their lives and due to the small size of the home, residents benefit from close support. This is achieved through regular consultation with residents on a daily basis as well as
Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 Page 12 via meetings. Two residents handle their own affairs and keep their own purse / wallet of personal monies. Records of transactions concerning the other resident were seen and maintained appropriately. Menus had been revised to reflect individual resident’s preferred tastes for cultural dishes. Natal Lodge DS0000025816.V277389.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 An appropriate complaints procedure is in place to ensure that the views of residents, their families and friends are listened to and acted upon. Standard 18 was assessed as met at the September 2005 inspection. 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 record book is kept and no complaints have been made either to the home or to the Commission for Social Care Inspection since the last inspection or within the last twelve months. Natal Lodge DS0000025816.V277389.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): X None of these standards were assessed on this occasion. Standards 19 and 26 were assessed as met at the September 2005 inspection. EVIDENCE: Natal Lodge DS0000025816.V277389.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, 28, 29 and 30 There is a small stable staff team who have mostly been provided with appropriate training although two care staff still need to receive some further training that is relevant to the specific needs of the residents. Although practices have been improved upon, full recruitment checks must be obtained for all staff to maximise protection for the residents. EVIDENCE: Due to the home’s small size, residents benefit from a family type environment and close support from a staff team who remain unchanged since the last inspection. Mr and Mrs. Anenden live and work in the home. Their two daughters also work there plus one senior trained staff and a part time cleaner. As previously identified, the proprietor has obtained the required checks for the outstanding staff member. i.e. An appropriate CRB and POVA First check was seen for the recently appointed cleaner. References were not available however and this must be addressed. The manager is therefore required to ensure that two satisfactory job references are in place as part of the documentation pertaining to all staff working in the home. Training for staff is accessed through the National Care Homes Organisation who organise 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. Although it is acknowledged that courses are planned for the forthcoming year, the owners should provide some in house training for their two daughters as an interim measure. It is also suggested that the manager develops an annual training and development programme for all the staff.
Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 Page 16 Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 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): 31 and 36 The manager has good experience, relevant professional qualifications and residents are valued, and cared for by a small but competent staff team. Improvements are needed with the staff supervision programme to ensure that individual staff receive regular support and guidance from the manager. Standards 33,35 and 38 were assessed as met at the September 2005 inspection. EVIDENCE: Both Mr and Mrs Anenden, the homes owners, remain in operational day-today control of the home. Mrs Anenden, the registered manager advised that she has recently completed studies for the NVQ level 4 management qualification and was awaiting verification from her assessor. This will therefore be checked at the next inspection. Both owners have acquired significant experience, skills and knowledge in caring for older people and continue to demonstrate good management practice. They have also qualified as nurses in mental health training as has the senior care staff employed. As required
Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 Page 18 previously and now outstanding, the owners need to implement a supervision programme for all staff. Records must show that all staff receive regular supervision sessions to show that job performance is monitored and career development needs are addressed. Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X 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 3 X X X X 2 X X Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES- 1 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 Timescale for action 17(2) Staff records must contain all the 30/04/06 Sch 4(6 c) information as listed in schedule 2 of the care homes regulations. Two satisfactory employment references must be obtained before staff commence work. 18(1a)(2) The registered provider must 28/02/06 ensure that each member of staff has formal documented supervision at least six times per year. (Timescale from previous three inspections not met) 19(5 b) For the owner’s two daughters, further training must be organised that is specific to the needs of the service users. i.e. in mental health awareness and diabetes. Records must be kept to evidence such tarining. 30/04/06 Regulation Requirement 2. OP36 3. OP30 Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 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. Refer to Standard OP18 Good Practice Recommendations The owners’ two daughters who work in the home should attend formal training on adult protection. (Repeated from September 2005 inspection although it is acknowledged that the home was awaiting course availability) That the home’s annual training and development programme is documented. (Repeated from September 2005 inspection) 3. OP30 Natal Lodge DS0000025816.V277389.R01.S.doc Version 5.1 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.V277389.R01.S.doc Version 5.1 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!
