CARE HOMES FOR OLDER PEOPLE
Olive Lodge Bedford Court Broadgate Lane Horsforth Leeds Lead Inspector
Sue Dunn Unannnounced 14 April 2005 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 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. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Olive Lodge Address Bedford Court, Broadgate Lane, Horsforth, Leeds, West Yorkshire Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2593800 Joseph Rowntree Housing Trust Mrs Margaret Anne Rhodes Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34 of places Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4 November 2004 Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 5 Brief Description of the Service: Olive Lodge, close to Horsfoth Town Street is a 34 bedded care home which has been purpose built to a high specification for the Joseph Rowntree Trust. The home is close to shops, library, a health centre and other amenities. The home has 4 studio apartments, which are unregistered and several bungalows, also unregistered, share the site and the homes amenities. The 34 rooms have single en suite accommodation and all exceed the minimum size requirements. All have French windows leading onto small balconies. Shared kitchenettes are well stocked to enable people to make their own snack meals and drinks. A main dining room and sitting area on the first floor is reached by stairs and a passenger lift. The menu offers choice and is open for consultation and amendment by the people who use the service. People living in the apartments and bungalows, and visitors to the home, can use the dining faciliites. All new staff are given a standard induction training. People living in the home are encouraged to take an active part to organise and be involved in a range of creative and social activites. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection, carried out by one inspector was unannounced and spanned a period of 6 hours. The purpose of the inspection was to ensure the home was operating and being managed in the best interests of the people living in the home and to meet the National Minimum Standards for a Care Home for Older People. Four of the 34 people in the registered part of the home were in hospital on the day of the visit. All the people who were in for lunch were spoken with briefly, two requested to speak to the inspector and others were spoken with during a tour of the building. Judgements made during the inspection were based on observation, information from the administrator, the deputy manager, three care workers, a community nurse, two visitors and six residents and examination of three care files. What the service does well:
The home is built in a good location close to all local amenities. Bedrooms are in excess of the minimum size requirements allowing sufficient space for items of personal furniture. Privacy has been given a high priority in the design of the home, all rooms have en suite wc and shower, and the lockable doors have letter boxes and doorbells reminding anyone visiting that each room is someone’s personal space. People choosing to move into the home are given all the information and support they need to make an unhurried and planned move. Staff respect people’s right to manage their own lives but can be summoned by a pendant call system to give support as required. The staff appear competent and professional. An active group of residents organise a monthly calendar of events in which all can join and share their skills. People from the unregistered apartments and nearby bungalows and any visitors to the home can stay for meals. Kitchenettes are well stocked to allow for drinks and snacks at any time. The outdoor space is a pleasant area for sitting with some rooms having their own patio or balcony. Recreational opportunities are available on the additional space allocated for allotments. There is a computer and photocopying machine for residents’ use. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 7 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. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5 The methods used to enable people to make an informed decision about moving into the home are good. The handbook is informative but would benefit from some colour and design to make for easier reading. The pre admission assessments are limited, being based on physical care needs. Information about the emotional and intellectual needs of people must be included if the home is to provide assurances before a person enters the home that their needs can be met. EVIDENCE: A new handbook is being developed. The contents of this were helpful but were not easy to read as there was no colour or pictures to provide direction for the reader. A person visiting the home to make an enquiry confirmed that she had been given a handbook with information about the home. The administrator spent some time talking with her and answering questions. She stated she visits everyone before they move into the home to explain the charges. The signed contract is backed up by a letter confirming the number of the room to be occupied.
Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 10 The pre admission assessment process is computerised and limited to identifying nursing/medical problems and risks. The assessment required explanation to make it understandable. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Service users were clearly satisfied with the care and their quality of life. Staff were able to discuss the level of care given and were mindful of each person’s personal preferences. However, the quality of care was not clear from the care files. The written care plans were inconsistent and lacked continuity. EVIDENCE: All the Service users were introduced during lunch in the dining room. Overall all spoke of their satisfaction with home and the helpful staff. People who were spoken with on their own gave personal opinions about details which they felt, if attended to, would make small improvements. One person said she was very contented and felt confident enough to be able to grumble without anyone taking offence. The quality of consistency and continuity varied in different care plans. One care plan had a request for chiropody written on an undated scrap of paper slotted into the front of the file, another gave details of the person’s history, which included interests. A form which had been completed to show preferred routines only recorded problems and had not been completed fully. A care plan for a person who recently moved into the home had a care plan for eyesight
Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 12 and social interests but did not have an action plan. It was not clear from an assessment for a bed rail if a bed rail was provided as an outcome. There was no action plan for the prevention of pressure sores, though this had been identified as an area of risk. Several different forms were in the files and it was difficult to know which were being used. The evaluation of a care plan simply showed no change and did not state how this conclusion had been reached. Care plan reviews showed that people had attended their review and been able to express an opinion. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The home has excellent systems to ensure that people have control and choice over the way they conduct their lives. The overall standard of catering gives satisfaction though some improvements could be made to ensure the satisfaction of everyone. EVIDENCE: A group of people who live in the home have been responsible for organising a range of social and recreational activities. All the service users who were spoken with said they were able to attend the activities which take place in the home. Some of the work from the sculpture and painting group was on display in the conservatory, people were observed going out and entertaining visitors in their rooms. The kitchenettes were well stocked so that people living in the home and their visitors can make drinks and snacks at any time. The majority of people were in their rooms watching TV listening to the radio or music. Two people expressed disappointment that the Quaker approach to life, in which people take an active part for the overall good of the community, is not as well developed as they had hoped. The main meal offered soup, a meat or vegetarian choice and a dessert with a light snack, sandwiches and cakes at tea time. One person felt the menus did
Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 14 not provide a healthy balance and was concerned by the unimaginative salads being served. The content of the salads provided at teatime was rather basic. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has an open attitude to complaints and residents are confident that any complaints and grumbles will be listened to and action taken if required. The staff have the knowledge to alert them to any behaviour which may be abusive and understand the action to be taken in order to ensure vulnerable people are protected. EVIDENCE: The deputy stated that staff are trained to recognise abusive behaviour as part of their induction training. She was able to give an example of a situation in which staff had raised their concerns and to describe the action which had been taken The people spoken with were confident enough to express their feelings about the home and make suggestions about how improvements could be made without any fear of repercussions. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The home is well positioned close to local amenities and thoughtfully designed to exceed the minimum standards therefore people living in the home can personalise their own rooms and have easy access to the local shops and amenities. The provision of handrails on the corridors would be of assistance for those people with poor mobility The standard of cleaning and maintenance is high and the home looks as fresh as it did when it opened. EVIDENCE: The home is designed, built and maintained to a high standard which supports privacy independence and rights. Many rooms have patios or small balconies which contained plants. An electric scooter assists less mobile people to access the short distance to the allotment area. All bedrooms are lockable (though few were locked) and have a letterbox and doorbell which staff are expected to use. Room sizes allow people to furnish
Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 17 their bedrooms rooms with items of their own furniture and personal possessions, therefore every room reflects the tastes of the person in occupancy. Each room has a telephone, lockable medication cabinet and an en suite bathroom with shower and lavatory. The rooms were well used for relaxation and entertaining. Moving and lifting equipment and assisted baths were seen during a tour of the building. There are no supportive handrails on the corridors which has on past visits been seen to be a problem for some people. One person was very happy with the standards of care given to the laundering service but was concerned about the open aspect of the ground floor rooms. An intercom system has been installed in the entrance hall for the use of visitors when there is nobody in the office. It was suggested that the sign drawing attention to this could be made more obvious and directional signs to the room numbers be shown Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The homes induction and training provides staff with the knowledge and skills necessary to provide an effective level of care. The staff appeared confident and competent. They maintained a discreet presence around the home but were readily available if anyone required assistance. The recruitment and selection process must be carried out in full for all staff to ensure the protection of vulnerable people. The staff must not compromise the care of people in the home by providing personal care to people in unregistered rooms. This can only be provided by an organisation registered to provide a domiciliary care service EVIDENCE: The manager was on holiday and the deputy was at an NVQ presentation with a member of staff, leaving the home in the hands of two senior care staff. She returned later in the day. In the meantime the care staff and administrator showed a good knowledge of the care needs of the people in the home and were able to assist in a competent manner. The home operates with 6 care workers in the morning and 5 in the afternoon. An agency carer came to maintain those numbers on the afternoon rota. It was found during discussion that care staff had been using hours rota’d for the home to provide personal care for a person in one of the unregistered rooms. This was a breach of registration. The deputy manager confirmed that 8 of the total of 21 care staff have the NVQ award with 6 working towards it. The staff were described as pleasant and helpful though one person felt that sometimes there seemed to be a lot of waiting about for assistance.
Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 19 Staff confirmed that they had formal supervision during which they can discuss any concerns, ideas and the progress of care plans. A list of supervision dates was posted on the wall in the manager’s office. A recently appointed care worker was originally employed as a domestic when the home opened and confirmed that she had been involved in the two week initial training for all new staff at that time. She had transferred into the care post without an interview or a new CRB (Criminal Record Bureau) check. The deputy manager was not aware that CRB’s are no longer transferable. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,36,37,38 The home sets out to follow the Quaker philosophy by incorporating the views and ideas of residents and staff at all levels with the managers having to consider the best interests of all. Quakers living in the home are in the minority therefore some feel there is a lack of participation by all residents. Systems are in place to ensure the safety and welfare of the people living and working in the home but more could be done to improve the information held in care files. The fire safety training for staff working at night must be given higher priority. EVIDENCE: The manager has completed the Registered Manager Award and the deputy manager is working towards it. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 21 Staff confirmed that meetings are held monthly for different sections of the staff team. An active residents group organises a calendar of activities and events. A maintenance person was able to show the records of all the routine safety checks he carries out and the general maintenance book used by staff to report any repairs. He had been enrolled to do a course on understanding dementia. Records revealed that there is no system for checking and recording the condition of bed rails. Records indicated that some night staff had not had fire drills. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 4 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3
COMPLAINTS AND PROTECTION 4 4 4 3 3 4 4 4 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x 3 2 2 Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 23 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 OP3 Regulation 14 Requirement The pre admission assessment must look at the whole range of needs and abilities of each person if the home is to give assurances it can meet needs Care plans must be in a consistent format and provide a continuous record of how care is to be provided and the outcomes of the care being provided CRB checks must be undertaken for all new staff appointments. All night staff must have regular fire drills and a system must be in place to regularly check bed rails Staff rotad to provide care in the home must not provide care for people who fall outside their registration The bed rails must be checked for safety on a regular basis Timescale for action By 31.07.05 2. OP7and 8 OP37 14,15 By 31.08.05 3. 4. OP29 OP38 19 23 By 31.07.05 By 31.07.05 Immediate 5. OP27 12,18 6. OP38 23 By 31.07.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Refer to Good Practice Recommendations
Version 1.30 Page 24 1. 2. 3. Standard OP1 OP15 OP22 The handbook could be made more interesting to read if it included some colour and design to direct the reader. The menus should be monitored to ensure that the needs of all residents are being met Consideration should be given to the provision of handrails on the corridors and clearer signing in the entrance foyer. Olive Lodge X000015_J52_S56917_OliveLodge_V186148_140405 Stage 2.doc Version 1.30 Page 25 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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