Inspection on 03/08/09 for Norfolk Lodge

This inspection was carried out on 3rd August 2009.

CQC 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 CQC 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

Norfolk Lodge 18/03/09

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Norfolk Lodge 32 Kings Lynn Road Hunstanton Norfolk PE36 5HT Lead Inspector Jane Craig Key Unannounced Inspection 3rd August 2009 09:30 DS0000072808.V377015.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norfolk Lodge Address 32 Kings Lynn Road Hunstanton Norfolk PE36 5HT 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) 01485 532383 ARMS Associates Ltd Mrs Sylvia Ince Care Home 23 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categories - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 23 18th March 2009 2. Date of last inspection Brief Description of the Service: Norfolk Lodge is registered to provide personal care for to up to 23 people older people who may have needs associated with dementia. The home is owned by ARMS Associates Limited, who also own two other care homes nearby. Norfolk Lodge is set in secure and well-maintained gardens in a residential area of Hunstanton. It is close to local amenities, including shops and the sea front. The home is a two-storey building. It has a mix of single and shared rooms, most of which have en-suite facilities. Bedrooms on the first floor are accessed by a stair lift. Communal rooms comprise two lounges and a dining room. There are assisted bathing facilities on both floors. Information about the home, including the latest inspection report, is available to anyone thinking of moving in. The range of fees is available from the manager. Extra charges are made for toiletries, hairdressing, newspapers, activities provided by external entertainers, transport and escorts to hospital and other appointments. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use the service experience adequate quality outcomes. The last key inspection of this service was carried out on 18th March 2009. This key (main) inspection includes information we have gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 3rd August 2009 by one regulatory inspector. At the time of the visit there were twenty one residents living at the home. We met with some of them and, wherever possible, asked about their views of Norfolk Lodge. We spent time observing daily routines in the home and how staff interacted with residents. Three residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager, members of the staff team and visitors to the home. We looked around the home and viewed a number of documents and records. This report also includes information from the annual quality assurance assessment (AQAA), which is a self-assessment report that the manager has to fill in and send to the Commission every year. What the service does well: People thinking of moving into Norfolk Lodge were provided with information about the home to help them to decide whether the service could meet their needs. Residents were offered a balanced and nutritious diet, with choices at each meal. Residents told us they liked the food. One said their lunch was, “excellent.” Visitors were able to come at any time, which helped residents to be able to stay in touch with their friends and family. A visitor told us they were always made to feel welcome. The service gave a commitment to dealing with complaints in a positive way. There was a clear procedure for anyone wishing to make a complaint. Since the last inspection the manager had also started to keep records of complaints, Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 6 which would help her to identify any general issues that people were unhappy about. There had been one complaint since the last inspection, this had been investigated by social services and found to be unsubstantiated. What has improved since the last inspection? What they could do better: After this inspection we made a requirement to make sure that there was no unnecessary delay in referring residents for medical attention if they were not well. We also made a recommendation that staff check bedrails to make sure that they remained in good working order and safe for residents’ use. We observed that there were certain routines in the home that had been established for the benefit of staff. Residents were assisted into their nightclothes during the afternoon, which could be viewed as disorientating and undignified. We were told that this practice was because there were not Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 7 enough staff to help residents to get washed and changed later on. We made a requirement that there must always be enough staff to support residents to meet their needs in the way they prefer. The recruitment procedure must be improved to ensure that thorough background checks are carried out before any new member of staff starts work at the home. There must be a formal system, which takes into account the views of residents and families, for monitoring the quality of the service provided at Norfolk Lodge. This is to ensure that the management team are able to identify and address any areas that need to be improved. There must be complete and accurate records of money received and spent on behalf of residents. This is to ensure that residents’ interests are safeguarded. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were not admitted to the home unless their needs were assessed and could be met. EVIDENCE: The combined statement of purpose and service user’s guide were given to people thinking of moving into the home. The document informed prospective residents and their families about the service and what facilities they could expect at Norfolk Lodge. A relative said that they had received some paperwork about the home before their relative was admitted. Anyone moving into the home was supplied with a copy of the terms and conditions of residency. This included information about the amenities charge, Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 10 which was a contribution towards toiletries and external entertainers and which we were told was optional. However, the terms and conditions were not clear about the position of residents who did not pay and whether they could still access entertainment. We made a requirement at the last inspection to ensure that people were not admitted to the home without having their needs assessed and being assured they could be met. There had been one admission in the past few months. The manager had obtained assessments from health and social care professionals before making a decision about whether Norfolk Lodge could provide the service to meet the new resident’s needs. She also carried out her own assessment, using the new assessment tool introduced by the company. The example we saw had not been completed in full. Standard 6 was not applicable. Norfolk Lodge does not provide intermediate care. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all residents’ health and personal care needs were met. EVIDENCE: A new format for care records had been introduced since the last inspection. Residents’ files were more organised and there were overall improvements in the care plans and associated records. Residents had personal profiles and life stories to assist staff to get to know them. As we required following the last inspection, each resident had a set of care plans to direct staff how to support them to meet their health and personal care needs. Plans were more detailed, which helped to ensure that staff all provided the same level of care. Some care plans also contained instructions to assist residents to maintain their independence and, therefore, Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 12 their dignity. We discussed how the addition of information about the resident’s likes, dislikes and preferences could help to ensure that staff delivered care in exactly the way the resident preferred. Each care file included a brief mental health assessment. Although care plans generally addressed residents’ physical and personal care needs resulting from their dementia, plans to support people with mental health needs did not. For example, plans did not direct staff how to support people with regard to needs associated with memory loss and disorientation. There were limited directions for staff to support a resident who had complex and aggressive behaviour but the staff we spoke to were clear and consistent about what strategies they used. Most care plans had only been written recently but there was evidence that they were being reviewed and changed as the resident’s care needs changed. Following the last inspection the manager had looked at the use of bed rails in the home and most had been removed. Residents who still used bedrails had appropriate risk assessments in place. However, there were no records of regular checks to show the bed rails were still safe. One of those we looked at had to be replaced because it was not completely stable. Care files included risk assessments associated with manual handling, pressure sores, falls and nutrition. There were corresponding plans to direct staff how risks could be minimised. We saw a good example of a strategy to monitor and reduce the risks of poor nutrition. We observed correct moving and handling techniques and use of equipment. Residents had appointments with district nurses, chiropodists, opticians and other health professionals. Residents told us that they were well looked after and they saw their doctor if they were not well. There was conflicting evidence with regard to this. For example, one resident’s notes indicated there was a delay of a few days before they were referred for treatment, after which they were admitted to hospital. However, another resident’s notes showed that the GP had been called out a few times during the course of a short illness. Records to support health care interventions were not all complete. For example, food and fluid charts for a resident whose diet was being monitored were not up to date. There were no records to show that a resident at risk of developing pressure sores was being assisted to change their position. There was a set of policies for medicines management and all staff who handled medication had received further training since the last inspection. Following a previous requirement, medication was stored safely in a locked trolley and disposed of safely when no longer required. There were complete records of medicines received and leaving the home, which meant there was a Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 13 complete audit trail. Any stock left at the end of the monthly cycle was returned to pharmacy. Most medication came from pharmacy in a monitored dose system (MDS). Following a previous requirement, other medicines were administered from their original containers, in accordance with the original instructions. Appropriate codes were used when medicines were omitted and there were no gaps on the medication administration record (MAR) charts. However, there were two examples where medication had been signed for but had not been given. This could be an indication that staff did not check and sign the chart at the time they administered the medicine. One resident had returned from hospital on a different medication regime than they went in on. Staff did not check the discharge prescription before administering medication and therefore gave one dose of the old medicines. This could have had serious implications for the resident’s health and safety. There were some handwritten entries on MAR charts. These were not double signed to show that they were checked for transcribing errors. There was a procedure in place for giving medication that was prescribed to be given ‘when required’. We discussed how this could be further developed to ensure that staff had guidance to show when individual residents needed this medicine. Some medicines that were prescribed with a variable dose had been recorded, which helped to evaluate the efficacy of the dose. There were no controlled drugs at the time of the visit. There was appropriate storage facilities should they be required. During the course of the visit we observed that staff were polite and respectful to residents. Personal care was provided in private and we saw staff knocking on residents bedroom doors before entering. We made a requirement after the last inspection to fit privacy locks on communal bathroom and toilet doors. Two out of three of these had been done. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not all residents had sufficient choice and control over their lives. EVIDENCE: The care plans we looked at all included a personal profile and life history of the resident. This helped staff to get to know residents better and gave them topics for reminiscence. Each resident had a care plan for social and recreational needs but these generally instructed staff to encourage the resident to join activities or mix in the lounge. There was little information about the individual’s current interests or abilities with regard to activity and occupation and how the staff could support them. The activity programme was mainly external entertainers or therapists coming into the home. Activity records showed people usually engaged in one main activity a week. Records showed whether they enjoyed it, which helped staff to evaluate which activities were popular. Staff said they did some activities when they had time. On the day of the visit there was a Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 15 brief ball game in the morning and afternoon, which several residents said they enjoyed. However, there were long periods when residents were sitting in the lounge asleep. A relative said they would like to see residents do a bit more than just sleep. There was open visiting, which helped residents to be able to keep in touch with their family and friends. A relative told us that they were always made to feel welcome and were kept informed if there were any problems with their relative. Some residents went out regularly with their families. Staff organised occasional trips out but they generally gave up their own time to take people out because there were not enough staff otherwise. There were a number of staff led routines in the home. There were bathing and toileting rotas. We also observed on the day of our visit that staff were assisting people into their night clothes at 4.30 in the afternoon after they had a shower. Others were in night clothes from that time onwards. We were told that this was because there were not enough staff in the evening to help people to get ready for bed. Although none of the residents were outwardly distressed by being in their night clothes so early in the day, it could intensify their disorientation. In addition, it was not a dignified practice and did not take into account residents’ choices and preferences. All the residents we asked told us they liked the meals. One described the food as, “excellent.” The records of meals showed that residents were offered a varied diet with two choices at each mealtime. The cook went around each day to ask residents what they preferred. Although a number of residents were not able to tell her, she was aware of their likes and dislikes. The cook had recently done a short course about dementia but it was not clear whether this included elements about food and good nutrition. We were told there had been improvements in the quality of the food since our last visit and there was now fresh fruit and vegetables each day. Residents were offered a choice of fruit as a snack to accompany their morning tea. We made a requirement at the last inspection to provide discreet and sensitive assistance to people who needed help to eat. The manager created a second dining space to allow more room for people who regularly needed help. Whilst this had improved the situation to a great degree, the tables in the original dining room were still too close together to enable staff to sit down when assisting residents. We saw that a member of staff had to lean over a resident in order to help someone else. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were protected by the complaints and safeguarding procedures applied in the home. EVIDENCE: A large print version of the complaints procedure was on display in the home. The procedure stated that the service viewed complaints in a positive way and gave a good explanation of how complaints would be dealt with. A relative told us they had no complaints about the service but would feel able to talk to the manager if they did have in the future. Following a previous recommendation, the manager kept records of concerns and complaints. There had been one concern and one complaint since the last inspection. The complaint had been made directly to social services. It had been investigated under safeguarding protocols and found to be unsubstantiated. The service had fully co-operated with the investigation and responded to the complainant as requested. Most staff had completed safeguarding training, which helped to ensure staff had the skills to recognise and respond to any reports of abuse or neglect. A member of staff told us, “I would be so angry if that happened, I would report Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 17 it straight away.” Senior staff were aware of how to respond if staff reported abuse but would benefit from a clearer procedure to refer to. The manager demonstrated an understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and how they impacted on the residents at Norfolk Lodge. She had put the legislation into practice to safeguard a resident who was assessed as being at risk if they left the home. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although improving, not all areas of the home were comfortable and well maintained. EVIDENCE: The programme of redecoration and renewal was ongoing. A new floor had been laid on the landing. A number of bedrooms had been redecorated and had new furniture, bed linen and laminate floors. There were plans to refurbish the remaining rooms. We identified several other areas where remedial work was needed, for example, the radiator covers and window ledges in the dining room were in need of repair and repainting. The lounges were in need of redecoration and the windows in one of the lounges and a bedroom were fogged and needed repairing or replacing. There was no maintenance plan to Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 19 show whether or not these issues were included in the refurbishment programme or when they were scheduled to be completed. Safety measures such as radiator guards and window restrictors were in place. The gardens were well maintained and provided residents with a pleasant place to walk and sit. There was one bathroom with a bath hoist and two shower rooms, which could accommodate residents with restricted mobility. These rooms were in need of some attention. For example, they were clinical and one of the bath hoists was rusting and looked shabby. Most residents had an en-suite lavatory and there were sufficient facilities near communal spaces. There were a small number of shared rooms. One did not have a privacy curtain in place but there were mobile screens available and the manager said one would be installed. The majority of residents had personalised their bedrooms with ornaments and small items of furniture to make them more homely and familiar. Residents we spoke to said they were happy with their bedrooms. Since the last inspection a key pad lock had been installed on the laundry door to ensure residents’ safety. The laundry was clean and well organised. The manager told us that it was adequately equipped for the size of the home. There were hand washing facilities but on the day of the visit there was no liquid soap, which made it difficult for staff to wash their hands immediately after handling dirty laundry. On the day we visited the exterior windows were in need of cleaning in several bedrooms, otherwise the home was clean and free from unpleasant odours. A relative told us it was always like that. Staff had completed infection control training but there were still some practices that heightened the risk of spread of infection. For example, a member of staff wore the same plastic apron for the whole morning and did not change it between assisting residents. The soap in the laundry had not been replenished. These practices could be an indication that some staff may not be following infection control guidance. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience Adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in recruitment practices and staffing levels could compromise the care and safety of people using the service. EVIDENCE: The manager told us that planned daytime staffing numbers equated to one member of staff for every seven residents. The duty rosters showed that there were sometimes more staff in the morning during peak times but there were also a few occasions when the numbers fell short, leaving only two staff at certain times during the day. Most of the staff we spoke to said that there were not enough staff. They said that the basic care was always provided but there were not always enough to organise activities or spend time talking to residents. Low staffing numbers also meant that some care routines were organised around the needs of staff and not residents. For example, we saw that staff helped some of the residents into their night clothes in the afternoon and early evening. We were told this was because there were not enough staff in the evening to help them all, especially as one member of staff was busy in the kitchen after tea. Night staff confirmed that residents were ready for bed when Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 21 they came on duty and anyone who needed two staff to help with the hoist was already in bed. There were only two staff on duty at night. This meant that during peak times, such as medication administration and supper time, there would not be enough staff to assist residents with personal care or to supervise them in lounge areas. The night staff told us that there were residents who occasionally needed help from two staff. This meant that at those times there was no-one to assist other residents. We looked at the files of two recently appointed staff. The files did not contain all the information and documents required to evidence that recruitment practices provided safeguards for residents. Both staff had two references. However, one had a reference from an employer that was not listed in their employment history. The other member of staff had two pre-printed references, which had not been validated. This member of staff had not supplied an employment history on their application form. One member of staff had started working at the home after their POVA first check but before their CRB was returned. We were told that this person was supervised at all times and did not work alone with residents. There were no records to evidence this. New staff had an initial induction period of two days when they learnt about the home and the residents, and were told about important policies and procedures. We were told that this had been cut by the proprietor to one day. This meant that new staff might not have sufficient knowledge, about the residents and what to do in an emergency situation, by the time they started working with residents. Following the initial induction, care staff, without an NVQ, went through a more thorough induction training programme, which met the Skills for Care common induction standards. We did not look at any records of these during the visit. Following a requirement at the last inspection, there were more opportunities for staff to attend training courses. There had been improvements in the number of staff with refresher courses in the ‘mandatory’ topics, such as moving and handling, food hygiene and infection control. Each member of staff had an individual training record but there was no central matrix, which made it difficult to see exactly what training still needed to be provided. Most staff had completed awareness training in dementia care. However, the lack of care plans to support residents with needs specifically related to dementia, may be an indication that they would benefit from more training in this area. The annual quality assurance assessment indicated that over half of the care staff had attained a national vocational qualification (NVQ) in care, at level 2 or above. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration systems were not effective enough to ensure that the home was always run in the best interests of the people living there. EVIDENCE: There had been some changes to the management structure since the last inspection. The registered manager had regular support from the manager of one of the other homes in the group. A new assistant manager had also been appointed, which meant she had more help on a day to day basis. The management and administration systems were generally more organised and the management team had worked hard to comply with the requirements we Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 23 made after the last inspection. However, shortfalls in staffing numbers, recruitment, care routines, records and quality monitoring indicated there were further improvements to be made in the area of management and administration. The service did not have a formal quality monitoring system. With the exception of regular medication audits, there were no internal checks or audits to ensure that the service was run in accordance with the policies and procedures. The manager told us that they planned to hold staff meetings but these had not started. The questionnaires for relatives had not been repeated since the last inspection and the results had still not been collated. There was no evidence of an annual development plan. The manager did not act as agent or appointee for anyone at the home. Most residents were assisted to manage their money by their families or other representatives. Some residents had small amounts of money held for safekeeping. Each resident had an individual cash sheet to record money received and withdrawn. However, two of the four records we checked were incorrect. Running balances were not always recorded. One resident had withdrawn money for chiropody treatment but this had not been recorded. Another had more money than the records indicated they should have. Receipts were not available for all transactions made. Staff received health and safety training. There was an employee health and safety handbook, which was read by all new staff. The handbook covered the main points of health and safety legislation, including responsibilities of all staff. Fire safety training was up to date. Staff we spoke with were aware of the procedure to follow in the event of a fire. Fire safety equipment was serviced and there were regular checks of fire alarms. The manager had a fire drill planned. Servicing and maintenance of installations, equipment and appliances were up to date. We made a requirement after the last inspection to store all potentially hazardous substances safely. This had been done. The manager had also completed a number of risk assessments to identify and reduce potential hazards in the environment. Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 24 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 1 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 X X 3 Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 25 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 OP8 Regulation 13 Requirement In order to promote their health and welfare, there must be no unnecessary delay in referring residents for medical attention. In order to promote their health and welfare, residents must receive the medicines that are prescribed by their GP or hospital doctor. The MAR charts must be an accurate reflection of the medicines that have been given. There must be enough staff on duty at all times to meet the needs of the residents. This would include ensuring that residents’ preferences for routines are respected. In order to provide safeguards for residents, all information and documents required under Schedule 2 must be obtained and retained before new staff commence work at the home. There must be a system for DS0000072808.V377015.R01.S.doc Timescale for action 31/08/09 2. OP9 13 31/08/09 3. OP27 18 31/08/09 4. OP29 19 31/08/09 5. OP33 24 30/11/09 Version 5.2 Page 26 Norfolk Lodge regularly monitoring and improving the quality of the service. This should include seeking and acting upon the views of people using the service. 6. OP35 17 In order to provide safeguards 31/08/09 for residents, there must be complete and accurate records of money handled on their behalf. 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 OP2 Good Practice Recommendations The terms and conditions should be clear about whether residents who opt not to pay the amenities charge would be able to access the external entertainment programme. The care plans should include personal information regarding residents’ likes, dislikes and preferences; this information would help staff to provide care in the way the resident preferred. Care plans should include directions to support residents to meet their needs specifically associated with dementia as identified in their mental health assessment. Records to assist in monitoring health care should be completed as directed in the care plan. These would include records of food and fluid taken and records of assistance to change position in bed. Bedrails should be checked regularly to ensure they are in a good state of repair and fit correctly on the bed. This is to protect residents’ safety. Handwritten entries on MAR charts should be witnessed in order to reduce the risk of transcribing errors. 2. OP7 3. OP8 4. OP8 5. OP8 6. OP9 Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 27 There should be clear guidance for staff when to give when required medication to ensure that residents receive medication they need. All variable dose medication should be recorded to enable staff to monitor the effectiveness of the dose. 7. OP12 The level and range of social contact and activities should be developed to ensure that residents individual needs are met. Residents usual routines, preferences and choices should be recorded on their care plans to ensure that staff are aware of, and can assist them to maximise, their choice and control over their daily lives. 8. OP14 Norfolk Lodge DS0000072808.V377015.R01.S.doc Version 5.2 Page 28 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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