CARE HOMES FOR OLDER PEOPLE
Norman Lodge 1a Glenroyd Avenue, Cleckheaton Road Odsal Bradford BD6 1EX Lead Inspector
Ann Stoner Announced Inspection 13th October 2005 9.40am 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 Norman Lodge DS0000033549.V270546.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. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Norman Lodge Address 1a Glenroyd Avenue, Cleckheaton Road Odsal Bradford BD6 1EX 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) 01274 691520 01274 675129 City of Bradford Metropolitan District Council Department of Social Services Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30th June 2005. Brief Description of the Service: Norman Lodge is a single storey, purpose built Local Authority residential and day care resource centre for older people. In addition to day care, the home provides residential care for respite, rehabilitation, assessment and permanent service users. Nursing care is not provided. Day care is not regulated and therefore is not inspected. The residential part of the home functions from four different wings, with one wing dedicated to rehabilitation. Each wing has a lounge, dining and kitchen area, and specialist equipment to enable and encourage independent living is provided on the respite and rehabilitation wings. The layout of the home allows all the wings to function independently of each other, yet still providing interaction whenever necessary. There is a hairdressing salon and a bar area selling alcoholic and non-alcoholic drinks each evening. People using wheelchairs have access to the well kept gardens and courtyards where there is outdoor seating. The home is located in the centre of a new housing estate, close to the city centre of Bradford. Local amenities include an off license, hairdressing salon, public houses, betting shop and newsagents. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 30th June 2005. There have been no further visits until this announced inspection. The registered manager’s post is vacant; the deputy manager has agreed to take on the ‘acting manager’ role on a temporary basis. This inspection was carried out between the hours of 9.30am and 5.15pm. During the inspection, I looked at records, saw care staff carrying out their work and spoke with residents, staff and the acting manager. Comment cards/questionnaires are left for residents, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection (CSCI). We discuss any comments received with the manager, without revealing the identity of those completing them. Seven have been returned, and no negative comments have been made. Copies of previous inspection reports are available via the Internet at www.csci.org.uk. What the service does well:
The home is very relaxed and informal and staff and service users enjoy a good relationship with each other. Service users are encouraged to live as independent a life as possible. One short stay service user said, ‘I live on my own and coming here makes a difference’, another person admitted for rehabilitation following a stroke said, ‘If you want any help they (staff) will always help you. As I have improved I need less help, but staff come straight away if I need them’. A returned comment card completed by a service user states, ‘After living her for a year in comfort and contentment, I have no worries as we are perfectly looked after. I know my remaining years here will be happy. The food is perfect and we receive excellent service from well trained staff.’ The management team is committed to providing a good standard of care for residents, and uses feedback from inspections as a measure of quality assurance. During the inspection, work was already taking place to address some of the issues that had been identified. This is commendable. The home is committed to staff training and development with 85 of staff having achieved an NVQ (National Vocational Qualification) at level 2 or above. The remainder are being assessed or are about to register as candidates. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 6 The home works hard at developing relationships with other professionals and is working in partnership with staff from the PCTs (Primary Care Trusts) on a new initiative aimed at improving older people’s mobility and stability. 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. Norman Lodge DS0000033549.V270546.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 Norman Lodge DS0000033549.V270546.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): 2 & 3. The lack of a written contract and statement of terms and conditions of the home leaves relatives, and/or service users receiving short stay, respite or rehabilitation care, unaware of the specific rights and responsibilities of both the home and the service user. No service user moves into the home without having his/her needs assessed. EVIDENCE: Contracts and terms and conditions are in place for long term service users but the acting manager said that these are still not available for short stay, respite or service users on the rehabilitation wing. Following a referral for admission, staff always carry out a pre-admission assessment in the person’s current environment. In the records sampled, the pre-admission assessments were detailed and contained relevant information. The home now obtains sufficient information before anyone is admitted on an emergency basis, and is therefore able to justify accepting the admission. The acting manager and the assistant manager are developing an assessment format that will be used for when assessing and monitoring those service users admitted for assessment. A social worker stated in the minutes of a recent
Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 9 review meeting, held on behalf of a service user admitted for assessment, ‘The assessment at Norman Lodge has been very helpful in clarifying the service user’s needs and level of functioning.’ Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9. Further work on care plans is needed to make sure that needs are not overlooked. The health care needs of residents are met. Some medication practices should be reviewed to protect service users. EVIDENCE: Some care plans are more detailed than others. Three care plans were sampled in detail and overall there appears to be a lack of understanding between assessment and care planning. One person’s communication plan stated that the service user was deaf but didn’t wear a hearing aid. There were no instructions on how staff should communicate with her. In discussions with staff it was clear that they hold detailed and specific information about service users, but this level of detail is not recorded within care plans. Information such as needs prompting to use the toilet, should be replaced with specific detail on how often staff should prompt. Information from NHS assessments is not always transferred to the care plans. In the case of one service user it was identified in her NHS assessment that she had gullet and swallowing problems, but there was no reference to this in her nutritional assessment or her dietary care plan. Nutritional risk assessments and skin assessments were completed for another service user,
Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 11 both of which identified her as being at risk, but there were no care plans in place detailing how the risks were being managed. Confidentiality is compromised with the details recorded in books, such as the goal therapy book held on the rehabilitation wing, and is not in keeping with the Data Protection Act. Information in care plans showed that service users access health care services such as chiropody, dental and optical services and GP visits are arranged as required. In line with the National Service Framework the home is taking part in a research project to reduce the number of falls in older people. As part of this research the environment has been risk assessed and any risks have been rectified. The acting manager explained how she completes a falls risk assessment tool, which when combined with a Bartel score indicates if the service user is at risk of falling. The home has received a £1,000, for the purchase of shoes and slippers for those identified in the at risk category. Some medication practices were sampled. It was noted that handwritten entries on MAR (Medication Administration Records) are not checked and countersigned by a second person. The self medicating risk assessment does not identify how the home has assessed the risk of the person being able to hold his/her medication. There is no system in place informing service users and/or their relatives of the need to tell the person in charge of any additional supplies of medication, or any homely remedies, brought into the home for use by the service user. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 12 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): These standards were not assessed at this visit. EVIDENCE: Norman Lodge DS0000033549.V270546.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 & 18. Complaints are taken seriously and service users are safe. EVIDENCE: Information on how to make a complaint is displayed throughout the home and the home has a robust system of responding to, and investigating, all complaints. Staff have a good understanding of issues relating to adult abuse, and one service user, who had only been in the home for two days, explained the purpose of the ‘No Secrets’ poster displayed within the home. This is impressive. Norman Lodge DS0000033549.V270546.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): These standards were not assessed. EVIDENCE: Norman Lodge DS0000033549.V270546.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 & 28. Staff are well trained, but staffing levels are inappropriate for the home and the service it delivers. EVIDENCE: The staffing levels are inappropriate for the building and the service it provides. The home provides care for 9 long stay service users, along with short stay care, respite care and rehabilitation care. The home functions from four different wings, which means that at some times there is only one member of staff working on each wing. Where a service user requires assistance from two members of staff, help has to be summoned from another wing, leaving the residents on that wing unsupervised. At night there are only two staff on duty to cover all four wings, staff said that this does result in service users having to wait for assistance. Admissions and discharges usually take place on the same day. It was noted that 10 discharges and 7 admissions were due to take place all on one day, which stretches the staffing resources to an unacceptable level. 85 of staff have achieved an NVQ (National Vocational Qualification) at level 2 or above and the remainder are being assessed or are ready to register as candidates. A member of staff, who is an NVQ assessor, said that she has dedicated time to complete the paperwork resulting from assessments. This is good practice. She said that in her opinion NVQ has improved and standardised practices within the home. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 & 38. In the absence of a registered manager the home remains stable. The health and safety of residents is promoted. EVIDENCE: The registered managers post is vacant and the deputy manager has accepted the role of ‘acting manager’ on a temporary basis. She has many years of experience in working in the home, and she holds both a social work qualification and the Registered Managers Award. In the absence of a registered manager the acting manager has maintained the high standards of care within the home, has communicated a clear sense of direction and leadership to staff, and has preserved the open and inclusive atmosphere within the home. She is committed to meeting the requirements and recommendations from this inspection. Service users who have savings with Bradford social services do not receive any interest for the first £500; this does not comply with the care homes regulations or guidance published by the Commission for Social Care
Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 17 Inspection. Individual statements are issued annually. The acting manager said service users could request a current statement at any time. This information should be readily available, without a request being made. The acting manager completed a pre-inspection questionnaire identifying that all the necessary health, safety and service checks have taken place as required. There is a training matrix identifying when mandatory training updates are required. Work identified in the fire officer’s report has been completed, and a recent environmental health report did not highlight any issues. It is recommended that when an accident is not witnessed a record be kept of when the person was last seen and by whom. A quarterly audit of accidents is kept, but it is recommended that the manager completes a monthly audit of all accidents within the home, so that any trends or patterns can be identified. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 4 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X 2 X X 3 Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (1) Requirement The service user guide must include: The statement of terms and conditions of the home. The contract. This is outstanding from 30.6.05 The registered person must give service users a contract showing the arrangements made. This is outstanding from 30.6.05 The care plan must set out in detail the action which needs to be taken by staff to ensure that all aspects of health, personal and social care needs of the resident are met. Where, as a result of completing a nutritional risk assessment and/or a skin assessment, a service is identified as being at risk, the appropriate nutritional and pressure area care plans must be put into place
DS0000033549.V270546.R01.S.doc Timescale for action 31/03/06 2. OP2 5 (3) 31/03/06 3. OP7 15 (1) 31/03/06 4 OP7OP8 13 (4) (c) 30/11/05 Norman Lodge Version 5.0 Page 20 5 OP9 13 (2) demonstrating how the risk will be managed. All service users who self medicate must have a risk assessment that shows the factors taken into account to assess the service users cognitive ability to hold their medication. This is outstanding from 30.6.05 In order to ensure accurate recording of medication all handwritten entries on MAR (Medication Administration Records) must be checked and countersigned by a second person. The registered provider must make sure that staffing levels are appropriate to the needs of the service. The registered provider must demonstrate how each individual service user will receive any interest applicable to their individual savings. 30/11/05 6 OP9 13 (2) 30/11/05 7 OP27 18 (1) (a) 31/03/06 8. OP35 20 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP7 OP9 Good Practice Recommendations Information about service users held in the goal therapy book should be transferred into the appropriate care plans. A system should be put into place informing service users, and their relatives, of the need to tell the person in charge about any medication or homely remedies brought into the home for use by the service user. The terms and conditions of employment should state that
DS0000033549.V270546.R01.S.doc Version 5.0 Page 21 3. OP29 Norman Lodge any new convictions (including motoring offences) must be reported to the manager. Norman Lodge DS0000033549.V270546.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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