CARE HOMES FOR OLDER PEOPLE
Scole Lodge Norwich Road Scole Diss Norfolk IP21 4EE Lead Inspector
Maggie Prettyman Unannounced Inspection 28th January 2008 09:30 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 Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 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. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Scole Lodge Address Norwich Road Scole Diss Norfolk IP21 4EE 01379 740646 01379 740479 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) Regal Healthcare Properties Ltd vacant post Care Home 28 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (28) of places Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Old age, not falling within any other category - Code OP Dementia - Code DE (maximum number of places: 1) Maximum number of service users who can be accommodated is: 28 1st March 2007 Date of last inspection Brief Description of the Service: Scole Lodge is a large detached building situated just outside the village of Scole near Diss In Norfolk. It is set in eighteen acres of grounds with mature gardens and meadowland. Bedrooms are on the ground and first floors and consist of two double and twenty-four single bedrooms. Nineteen of the single rooms and both the double rooms have en-suite facilities. The home has a variety of communal rooms for the residents’ use. A shaft lift and a wheelchair lift are provided to aid residents to the first floor, which is on three levels. The home informed CSCI of its charges in January 07 and charges residents from £347 to £500 per week for care provision. Residents pay extra for hairdressing, chiropody, optician, dentist, newspapers and toiletries. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the provider, some residents and their relatives as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and current judgements for each outcome group. This inspection took place over the course of 7 hours and included discussion with residents and their visitors, inspection of files and written records, a tour of the premises and observation of staff conduct and interaction with people who live at the home. Prior to the inspection a detailed Annual Quality Assurance Assessment was completed by the home and submitted to the Commission. In addition, several confidential questionnaires were returned to the commission by residents and their relatives or representatives. Other information which the Commission receives between inspections may also be taken into account in inspection reports. What the service does well:
Scole Lodge is a home with a pleasant atmosphere and décor. It is clean and tidy. Staff clearly work hard and are committed to providing a warm, kind and caring service. Residents feel that they are treated in a respectful way. Whenever possible the staff take the time to sit and talk to people living at the home. One person said “They are always polite and kind to you here. People are always spoken to nicely and the staff really do care” The home has worked to survey people about their needs and wishes, and changes its service to reflect this. Resident meetings are held and again action is taken as a result. People enjoy the food provided by the home. One relative commented, “The quality of the food is really very good. The vegetables are always well cooked and full of flavour” Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 6 People bring their own possessions to the home, and each person’s room is individual and homely. What has improved since the last inspection? What they could do better:
This kind and caring staff team have worked hard to improve standards since the last inspection. Unfortunately limitations and cutbacks on the part of the provider have been the root cause of the majority of requirements and recommendations that are made at the end of this report. There are some things the home must do by law. These are: • • • • • • • • • The new care plan system needs to be consistently completed Detailed information about peoples health care needs must be recorded The activities programme at the home should be reintroduced Complaints, (and changes made as a result), should be available for inspection All mandatory staff training should be regularly updated and accurately recorded Health and safety concerns identified during the inspection must be addressed Staffing levels must be sufficient to meet the needs of residents at all times Food hygiene training must be given to staff with responsibility for food preparation Staff must be suitably inducted and supervised. We have recommended some improvements which the home can choose to put in place, but they don’t have to do this. These are: • The Service Users Guide should accurately reflect the service provided
DS0000067738.V358583.R01.S.doc Version 5.2 Page 7 Scole Lodge • • • • • • Community links with the home should be improved People should continue to be encouraged to gain NVQ in Care All references should be original or verified as such Training records should be kept accurately and up to date The provider should consider whether tasks expected of the management team are within their current skills and resources and provide assistance if not All bathing areas should have adequate heating 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. The summary of this inspection report can be made available in other formats on request. Scole Lodge DS0000067738.V358583.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 Scole Lodge DS0000067738.V358583.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are individually assessed before they come to live at the home. However, the information given by the home about activities is incorrect and should be altered to reflect the limited activities currently available. EVIDENCE: The information given to prospective residents and their representatives was seen. Changes in staffing provision mean that there is no current programme of activities. The information given to people should be changed to reflect this lack of provision. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 10 Contracts for service provision that meet the standards were found in place for those residents whose files were checked. The admissions process was studied for the most recently admitted resident. This was an emergency admission, so some information is yet to be gathered. However the person’s representative was interviewed and they described a caring, sensitive and detailed assessment of need and wishes. This process was undertaken in difficult circumstances and, despite this, a good level of information was gained. Scole Lodge DS0000067738.V358583.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The recently implemented care planning system has not been fully completed, leaving many areas of health and personal care unaddressed. Medication systems are operated safely and people’s privacy and dignity are respected EVIDENCE: Examination of recently introduced care plans demonstrated that they are incomplete and do not appear to have been drawn up in consultation with individual residents and their families. Many areas of health and personal care are indexed, but no information was available. No signatures of residents or their representatives agreeing to elements of the care planned were found. Whilst it is understood that this is a new system, comprehensive information about all aspects of peoples care must be readily available at all times. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 12 Evidence in files demonstrated that the quality of needs assessment has improved since the last inspection. Evidence of support of people’s health care needs was seen in terms of a variety of medical appointments and individual nutritional assessment. The GP and district nurse visited the home during the inspection, but were not available to be interviewed. Incomplete care plans meant that it was difficult to get a picture of how well the home meets health care standards. Information gained with regard to dietary requirements was contained in a file in the office. Information about these needs was briefly noted in the kitchen, but no evidence of more detailed information was found there. Part of a medication round was observed. Medication records and quantities of medication were checked and found to be accurate. The home has improved its service to residents in this respect since the last inspection. During the inspection staff were observed treating people with respect and dignity. People interviewed during the inspection confirmed that this is always the case. Screening was used appropriately in shared rooms and individual toiletries were appropriately stored and individually labelled. People have private telephone lines in their rooms, or can use the homes mobile phone handset in private. Evidence of people’s letters being given to them unopened was seen. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have limited social activities and access to their local community. They are able to make choices in their daily lives and enjoy the food provided by the home. EVIDENCE: The member of staff who previously planned activities has left and has not been replaced. Whilst staff were seen to do their best to offer people individual stimulation, this lack of a coordinated activities plan means that it can be inconsistent. Incomplete care plans meant that information about people’s individual interests is not always available. A minister of religion visits the home regularly, and individual spiritual needs are recognised. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 14 The residents of the home have little contact with the wider community other than with their own relatives and friends. With the exception of the visiting minister, the home has no involvement with external groups or organisations. During the inspection a number of relatives and friends were observed visiting the home. They were greeted warmly by staff, and have access to tea and coffee making facilities. A resident confirmed that her relatives feel welcome at the home and that they can stay for meals if they wish. People said that they feel in control of their lives, and that they can spend their days as they wish. Every room seen contained personal and private possessions which are treated with respect by domestic staff. Most of the clothes found in the laundry were individually labelled, and information about this was found in the Service Users Guide. The home has residents’ meetings and choices expressed at these are incorporated into the daily running of the home. Inspection of the kitchen found it to be clean and tidy with good quantities of fresh fruit and vegetables available and in use. The cook demonstrated professional standards and a keen interest in the welfare of people living at the home. A menu is followed which has been changed recently following requests from residents. People interviewed spoke highly of the main meal and said that they enjoy it and it is well cooked and presented. Some issues exist with regard to food provided later in the day. The afternoon cook has left and care staff are now expected to prepare and serve afternoon tea and supper in addition to their care duties. Concerns have been raised elsewhere in this report in respect of implications for staffing levels and food hygiene training that this has created. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. No consistent recording or analysis of complaints and their outcomes is kept by the home. Adult protection training is not updated. EVIDENCE: The home’s manager had difficulty in finding records of complaints. Two formal complaints have been received, but records of their investigation and their outcomes in terms of changes in practice were not available for inspection. Staff training records showed that the vast majority of staff have not had updated adult protection training since 2006. Induction records for staff employed since this time were often incomplete or not available in this respect. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 25 and 26. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has worked to address recommendations made in the previous report to improve the environment that people live in. Further improvements still need to be made. EVIDENCE: Since the last inspection improvements to the garden and bathrooms as well as other areas of redecoration have benefited people living at the home. The home appears to be well maintained and has a pleasant and fresh atmosphere. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 17 During a tour of the premises some safety and practice issues were identified which need to be addressed. • • • • • Heating appears to be inadequate in a newly installed shower room Window restrictors were not in place on all upstairs windows One sluice was found to be untidy and unhygienic A staff kitchenette needs to be locked as electrical appliances were placed near to a water source. The laundry door needs to be locked as cleaning materials were stored here outside secure cupboards With the exception of the sluice, the home was found to be clean, pleasant and hygienic. The laundry is well equipped and special bags are now used to safely transport soiled linens. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who work in the home do not always have the ongoing or updated training that they need. Staffing levels in the afternoon put people at risk. EVIDENCE: During the inspection it became clear that staffing levels at the home have been reduced recently. The home does not currently have an activities worker. This has been addressed elsewhere in this report. It is of considerable concern that there is now no longer a cook to prepare food served after lunch each day. Three care staff are on duty to attend to people’s personal care needs and they also have to prepare, cook and serve the later meals of the day. Of the potential 28 people living at the home, at least four people currently need assistance with eating. These staffing levels are clearly inadequate and need to be urgently addressed. The home is currently falling short of its NVQ targets, with only 37 of staff with this qualification. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 19 A selection of staff files was inspected. Files were generally complete and met the minimum standards of vetting required. Overseas staff files contained copy references with no evidence of validation. Training records held by the home were inaccurate and it was difficult to verify training undertaken, and whether it had been updated. Induction training records for staff employed seven months ago had not been completed. Other more recent induction files were not available for inspection. There appears to be a shortfall in both induction and mandatory training. The organisation does not now appear to have a co-ordinated in-house training programme. It is of particular concern that staff performing personal care duties in the afternoon are being required to prepare food without any food hygiene training at all. The combination of personal care activity with food preparation without appropriate training poses a serious risk to people who live at the home. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Changes in management, training shortfalls, inadequate staffing levels and associated health and safety concerns mean that people living at the home do not experience a consistently well-managed service. EVIDENCE: The acting manager is an experienced person who has worked in care for many years. She has an NVQ 4 in care and is studying for her Registered Managers Award. She is also applying for registration with the commission. During the inspection she demonstrated commitment to the home and a consistently
Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 21 caring attitude. Unfortunately organisational matters beyond her control mean that staffing levels have been reduced and in-house training systems and recording have been discontinued. The organisation has also chosen to implement a new care planning system at a time when she is newly appointed and getting to grips with running the home. The work involved in this process has led to staff supervision not taking place and other administrative tasks not being fully completed. The home has conducted quality assurance surveys and regularly submits reports to the commission about the care and services provided. The manager stated that the home does not handle money on behalf of residents. The home recently tried to implement a system of supervision. This has not been consistently maintained. Induction records were either missing or incomplete. Staff are given an induction file, but this does not seem to be followed through by the home. A tour of the premises and observation of staff practice showed that, with the exception of the laundry, COSHH substances are safely stored and handled. Maintenance records were inspected and found up to date. Lack of consistent records meant that we were unable to verify that mandatory training is updated. It is clear that food hygiene training is not in place and is potentially putting people at risk. Accidents are reported and recorded. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 22 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X 2 3 STAFFING Standard No Score 27 1 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X N/A 1 X 2 Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The Registered Person must ensure care records contain a full written care plan setting out each person’s needs in respect of their health, personal and social care needs and how these needs will be met. These plans should be compiled in consultation with the resident concerned Repeated requirement. Information about people’s nutritional needs must be given in full to the kitchen staff. The registered person must ensure that all parts of the home to which residents have access are kept free from any hazards. Items requiring attention are noted at standard 25 of this report. After consultation with residents the home must promote a consistent and stimulating programme of individual and group activities. Timescale for action 30/04/08 2. OP8 15 (1) 17 Schedule 3 (m) 13 (4 a) 31/03/08 3. OP38 31/03/08 4. OP12 16 (2) m 31/05/08 Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 24 5. OP16 22.8 The home must keep an accurate record of complaints investigated and action taken as a result of investigations made. The home must ensure that all staff are trained in adult protection, and that this is regularly updated. 31/03/08 6 OP18 13.6 31/05/08 7. OP27 18.1a, c(i) Staffing must be adequate to provide the levels needed to deliver a safe and consistent service. This particularly relates to the provision of meals, assistance with eating and activities at the home. 18.1( c) All staff working at the home must have up to date mandatory training. In particular staff responsible for the preparation of food must be suitably trained or supervised. The home should ensure that all staff are properly inducted and supervised. 31/03/08 8. OP30 31/05/08 9. OP36 18.2 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP21 OP1 OP13 Good Practice Recommendations The registered person should ensure the warmth of the bathrooms at the home. The Service User Guide should accurately reflect the amount of activities provided by the home. The home should work to improve community links for the
DS0000067738.V358583.R01.S.doc Version 5.2 Page 25 Scole Lodge people that live there. 4. 5. 6. 7. OP28 OP29 OP30 OP31 The home must continue to work toward its NVQ targets. All references relied upon by the home should be originals or verified copies of originals. Accurate records of staff training achievements should be kept. The organisation should consider whether maintenance of existing systems and the introduction of new systems is workable and within the time and resources of a new manager. Scole Lodge DS0000067738.V358583.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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