Inspection on 14/08/07 for Palmtree Lodge

This inspection was carried out on 14th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI 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

Palmtree Lodge 08/06/06

Palmtree Lodge 12/01/06

Palmtree Lodge 26/07/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Palmtree Lodge 20/28 Nutter Road Cleveleys Blackpool Lancashire FY5 1BG Lead Inspector Ms Jenny Hughes Unannounced Inspection 14th August 2007 10:00 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 Palmtree Lodge DS0000063455.V340292.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. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Palmtree Lodge Address 20/28 Nutter Road Cleveleys Blackpool Lancashire FY5 1BG 01253 852092 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) palmtreelodge@tiscali.co.uk Mr Naveed Yousaf Muhammad Fayyaz Chauhdry Mrs Isabel Janet Robinson Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (19), Physical disability (3) of places Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered to accommodate a maximum of 22 service users, to include: *up to 19 service users in the category OP (older persons 65 and over). *up to 2 service users in the category PD (physical disability) who must be 60 or over, and 1 named service user in the category PD who is under 50. Date of last inspection 8th June 2006 Brief Description of the Service: Palmtree Lodge care home is situated within Cleveleys town centre, only a short walk from shops and close to the sea front. The home provides residential care for twenty-two persons on ground and first floor levels. All bedrooms have ensuite facilities and comply with minimum space requirements. There are two lounges and a dining/lounge area. The home has been fitted to suit the needs of older people, with, for example, a passenger lift, grab rails and ramps. There is a small front patio area with benches for residents to enjoy watching the daily comings and goings in the town. There is very limited car parking to the rear of the home, although cars can be parked in nearby roads, and a public car park is nearby. Information about the service the home provides is available in the form of written guides, which try to cover everything a resident needs to know about life in the home. Copies of these can be found in the entrance hall of the home, or are available on request from the manager. The latest report from the Commission for Social Care Inspection is also available in the entrance hall. As at 14th August 2007, the fee scale ranged from £294 to £423 a week, with additional charges for chiropodist and hairdresser visits, and any extra newspapers and toiletries requested. Further details regarding fees are available from the manager. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 5 Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit to the home, in that the owners were not aware that it was to take place. The length of the visit was for 6 hours. Every year the registered persons are asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of their service. We use this information, in part, to focus our assessment activity. Surveys were sent and received from residents and their relatives, and visiting professionals. During the inspection visit, staff records and resident care records were viewed, alongside the policies and procedures of the home. The owner, manager, residents and some care staff were spoken to. Their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, laundry, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: What has improved since the last inspection? A manager has been appointed, and has been registered with the CSCI. The outside of the home at the front has been decorated, and an attractive patio area where people can sit has been made. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 7 What they could do better: Information provided to people about the home could be more complete, with staff experience and qualifications. Available information in the home should be checked to make sure it is always up to date and complete. Pre-admission assessments should always be made, as people have been admitted without these, who have specialised needs the staff are not trained to meet. Reviews for each person could be more individual and practical, and linked to incidents, such as a fall, or a change in medication, or psychological or social needs. Activities could be more frequent and more stimulating for each individual, and included in the care planning process of each person. The environment needs to be, in places, structurally improved, such as the laundry, and also generally refurbished throughout, including the dining room, lounges, corridors and bedrooms. Many furnishings are worn and stained, and although some new carpets and beds have been provided, others need replacing. Some strong odours need to be dealt with by regular cleaning of carpets and other furnishings. Crockery and cutlery is also well used, and needs replacing. The water temperature needs to be monitored more closely, to make sure people are protected from the possibility of scalding, as in some bedrooms the delivery of water was very hot. Systems used in the laundry could be improved, to make sure people always receive their own clothes, and infection is prevented. Staff must only be recruited following full checks made of their suitability, with references from past employers as well as Criminal Record Bureau (CRB) checks. Staff should be deployed around the home in the best way to provide good care, both physical and social, to the residents. Audits and internal reviews of the quality of the care provided could be better, with evidence of meetings and feedback from residents and their relatives, and development plans which are based on the outcomes for people living at the home. There could also be better evidence of audits of records, to show there is monitoring that the best information is being gathered. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 8 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. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 9 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 Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 10 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 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information the home gives to people about the services available is not always complete. Information is not always gathered about people who want to live there, meaning that proper decisions cannot be made by prospective residents about the suitability of the home. EVIDENCE: A copy of the Statement of Purpose for the home is available in the entrance hall. This informs on who the owners and manager are, and what services the home provides. A copy of the Service User Guide is also available, which gives more detail as to the day to day running of the home for the people who live there. At the visit, the documents available in the entrance hall were not complete, and these need to be regularly checked to make sure all the information is available. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 11 The information was clear, but more detail on staff training and qualifications is needed. One relative commented on a survey that they were not told about care staff qualifications. Another felt that due to quite a high staff turnover, they were unsure of any staff qualifications or experience. These documents should also be reviewed to make sure they are up to date and complete, and residents and their families should always be kept well informed. Individual records are kept for each of the residents, and there is a set procedure for admitting someone to the home, with a pre-admission assessment form being seen on three selected files. These assessments are used by management to check that staff can give suitable care to each person, before the manager agrees that the home is the right place for them to live. The decision made on what help is required is discussed with the resident and their families, and they sign the documents in agreement. In one instance this procedure was not followed, and one resident accommodated at the visit had no pre-admission assessment, and was not in the registration categories of the home, so should not have been accommodated there. Care plans had been signed by a family member. There was no evidence of any participation by the resident in the agreement of his accommodation and his care. Staff are not trained in the specialist needs required to care for this resident. Staff spoken to were aware of the needs of the residents, and generally how to meet those needs. New staff said they felt well supported and guided in their work to provide the right care to the people living in the home. Response to a survey by a GP stated that the carers usually meet people’s health care needs, and they usually have the right skills and experience to support their social and health care needs. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a care planning system in place that is not always used efficiently, meaning that the health and personal care needs of the residents may not be fully met. EVIDENCE: Three resident files were selected, and it was noted that individual care plans are available, identifying the areas of need for each person, and with instructions for staff for what they must do to meet that need. The plans cover the health needs, personal needs, and social needs each person may have. A resident profile gives background information about the person, so that staff can try to understand each individual better. The system used means that events occurring, and the actions taken, should be easy to follow, with any changes being monitored. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 13 However, the systems used must be consistent to be efficient, for example, it was noted that some visits from a health professional, recorded in ‘daily notes’, did not always link to the ‘medical professionals visit’ record sheet, which would hold information about any treatment. Falls by residents were not all recorded in daily notes, therefore with no prompt for staff to monitor the resident. Accident records had been completed, but filed on individual files, leaving no clear overall picture for the manager to monitor during her audits. It was not clear what arrangements were in place to help residents who were at risk of falling. Not all residents had nutritional screening and weight checks carried out. Records were seen of monthly reviews of individual’s needs, made by the assistant manager, indicating where there were any changes, so that staff are then informed of any changes to the care provision. There are formal handovers of information from the management when shifts change, to confirm these updates to all of the staff. The care plans were signed and dated by the resident, or their representative if the resident was unable to, to show that they were involved in deciding what the care needs were. The manager had identified difficulties with providing the right care to one resident. The manager was advised that liaison should take place with social services in these circumstances, to prompt a re-assessment and enable the person to receive more appropriate care in another residence if necessary. Staff care for people with diverse needs, for example there are residents from different cultural and social backgrounds. Records hold information about the differing needs, and in speaking to staff they were aware of how they should care for the individuals. “Very pleased with the level of care staff give” and “On the whole the care is satisfactory and meets the requirements”, are comments made on surveys returned. The Alliance pharmacy has recently made a visit to the home, when advice and guidance was given, and this has been followed in accordance with legislation. Systems have been developed from this and the procedures have been updated. Medication is stored in lockable secure trolley, with a designated controlled drugs cupboard. Only named trained staff administer medication, and staff were viewed doing this at lunchtime. The manager must make sure all medication is signed for as it is taken by residents, including ‘when required’ medication. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 14 Residents can choose to go where they wish in the home, and may see visitors in the lounges or dining room, or in their own room. Some residents prefer to stay in their own room, where staff were seen to knock and wait for an answer before entering. “I’m happy to stay here and watch the world go by”, said one resident. “They pop in and bring me drinks and things. I’d rather be here than in the lounge, I can see out of the window better”. As he spoke a carer knocked and waited for an answer before bringing in a cup of tea and biscuits. The manager needs to ensure respect for standards for residents are kept by staff, who provided a cup with no saucer, and carried biscuits in her hand. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals were nutritious, and mealtimes relaxed, which encourages residents to enjoy food and mealtimes. There are very limited social activities, meaning that people are not being provided with stimulation, and not being given the opportunities to live lives that are as fulfilled as possible, EVIDENCE: The individual care plans include information on each person’s life history, their religious needs, and which hobbies and activities they prefer. An activities book records what activity has taken place, with who has enjoyed it and who has not. This had not been fully completed at the visit. The manager said that this record helps to find activities all the residents like. A member of the clergy visits the home, and a volunteer church visitor. A couple of residents are able to get out for a walk without assistance. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 16 There are very limited activities taking place in the home. A T’ai Chi instructor visits regularly, providing easy armchair exercises, and a hairdresser visits. A Summer Fayre took place at the home, and children from a local dance school recently performed there. However, there are no planned daily activities, and little social contact with staff was noted. “There are not many activities and outings arranged” was a survey response, and “By encouraging a little more personal contact with residents, things could improve”, stated another, and finally “A little bit more motivation should be introduced. I do realise that it is extremely difficult to motivate older people, but perhaps different approaches or different interests could be introduced”. The manager said she was keen to develop a more varied and constant activities programme, and this will be viewed at the next visit. Residents spoken to said that they would like visitors to have a chat with, and that staff were always too busy to do that. “There’s some dominoes over there”, said a resident, “I don’t always want to play that too much. You just want someone to talk to because you just sit here all the time”. “I hardly see any staff. They don’t come in here to see us and have a chat”, said another. The owner said that he does not get involved with residents’ finances, which remain the responsibility of each individual’s family. The sample meal taken was a roast beef dinner, followed by a strawberry flavoured dessert. It was well cooked, with fresh vegetables. All the residents seemed to enjoy their meal. Those needing help were assisted tactfully, with carers chatting all the time. The cook said she tried to respect peoples choices and different tastes. One resident enjoyed home made fish soup, and pigs’ trotters, while another liked an occasional curry. She said she sometimes made them especially for them, which the residents confirmed. She said she had a set menu to follow, but sometimes changed it to what was available. The cook was advised to provide a menu board so that people knew what their meals were to be, and be provided with an alternative if they wished. The residents spoken to said that mostly the meals were good. A response from one survey suggested that “there is not much variety with meals”, and another said “too many stew like meals”. Towards the end of the lunch time it was noted that a visitor used the kitchen as an exit. This should not happen during any time when food preparation is taking place for food hygiene and health and safety reasons. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon. Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a complaints procedure in place, with a complaints book to record any complaints, which may come to the manager’s attention. There have been two complaints brought to the attention of CSCI since the last inspection, regarding the care provision and the environment people live in. The investigations have not yet been completed. The correct formal procedures have been followed, and the owner and manager are open and informative. Residents spoken to said they would “tell any of the staff” if they were not happy with something. “If I have any problems I let the carer know and it is usually sorted out straight away,” stated a relative on a survey. Staff spoken to knew about the Adult Protection procedure, and what to do if they had any concerns. They said they would always act if they thought a Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 18 resident was at risk. Also if it was a member of staff causing concern they would inform the management. All staff attend abuse awareness training. A new staff member spoken to discussed how she had used the whistleblowing procedure in a past employment, and how she felt it was up to her to make sure “these people” are protected and looked after properly. She clearly understood her role and duties. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 19 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 19,24, 25 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The environment is generally comfortable and safe, but the overall quality of the furnishings and fittings is poor, and does not always create a very pleasing place to live. EVIDENCE: The owners tried to do as much redecoration as possible when they bought the home just over a year ago, and the outside of the home was soon refreshed and looked smart and tidy, with boxes of flowers brightening the front area through the summer. There is no garden area to this home, so this small front patio space has seating if any individual wishes to sit outside. Some fresh paint and curtains made an initial improvement at the last visit, and new carpets have been fitted in some bedrooms and the lounge, but the Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 20 standard of the furnishings needs to be addressed, as many are old, worn and stained. Most bedrooms have divan beds with no valances, and a few divan drawers were broken, all giving a bare, uncared for appearance. Some beds were very stained. Worn, dirty and stained carpets were seen in some rooms, and the various pieces of furniture were often old, marked, stained or seemed fragile. Bedding and some curtains were also well used and could do with replacing. Some rooms were very odorous, with carpets that needed cleaning or replacing. There is fluorescent strip lighting around the home, which does not give a homely appearance. The dining room’s décor is very poor, with cracked, marked paintwork. Tables and chairs are old and worn, and cutlery and crockery look well used. Plastic tablecloths do not help achieve the homely environment needed. The kitchen floor needs repair to meet health and safety needs. Staff complete a maintenance record if they note any minor jobs, for example broken drawers, or bulb to replace, and a maintenance man completes the task. This should be signed and dated to confirm it has been done, and when. “Slow to address minor repairs in a residents own room”, was a comment made by a relative. The laundry room needs complete refurbishment to have readily cleanable floor and wall finishes. The manager and staff have training in infection control. “The laundry is sometimes mixed up and things go missing” and “needs a better routine with the cleaning and laundry” were comments from relatives on surveys returned. The owner said that there are plans to update furnishings and décor over time, which included a complete refurbishment of the laundry area to make it a more suitable environment to work in. The manager confirmed that she recorded what improvements were needed in each room for the owner. The dining room is due for refurbishment, with new tables and chairs and carpeting, and some lounge chairs are due to be replaced. She also discussed her awareness of the problems with laundry and the standard of the cleaning, and how this was to be addressed with new staff now appointed to carry out the tasks. She confirmed that new residents and relatives were advised to name all articles of clothing to ensure the staff knew who to return them to after laundering. Water temperatures were randomly checked, and while in some rooms water delivery was at an acceptable temperature, others were not, being at too high a temperature which could cause scalding. The manager said that the water supplied to residents is regularly spot checked in bedrooms, but was advised Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 21 that every room should be checked and adjusted where necessary, as the temperature can vary in different parts of the building. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 22 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear recruitment procedure in place, which is sometimes not fully completed before staff start work, which could put residents at risk. The residents are supported by trained staff, who are generally in sufficient numbers. EVIDENCE: The records of two new staff recruited were viewed. The home has a formal recruitment policy, which had not been followed completely. Both staff had commenced employment, under supervision, following receipt of a check against the Protection of Vulnerable Adults list, but the required two references from previous employers had not been received. Staff should not start until all checks have been made. The manager was advised to show evidence of verbal contact with referees and reminders to them to show efforts had been made to obtain the references. Full induction training is provided to new staff, who are constantly guided until they feel confident enough to carry out tasks unsupervised. “It still feels unfamiliar to me, but the staff and manager are really approachable, and so I feel happy to ask questions on how best to do things”, said one new staff member. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 23 There have been a few changes in the staff team over the last year, but some long term staff remain to help guide the new staff, and retain some consistency for the residents. The changes can cause concern, as one relative stated “Staff turnover seems to be high, so we are unsure of carers relevant experience”, showing the importance of constant communication. Any disciplinary procedures needed have been dealt with correctly and efficiently by the owner. Training records were seen of courses attended by staff, which included moving and handling, abuse in vulnerable adults, infection control, fire prevention and evacuation, nutrition and dementia, medication awareness, and health and safety. Staff have also been accepted on NVQ Levels 2 and 3 in care training, with 38 already holding NVQ Level 2 or above. “I think were well looked after”, said a resident, “they seem to know what they’re doing”. Staff rotas were available, and showed appropriate numbers of staff on duty through the day. The manager’s own quality assessment stated that over the year more staff have been provided to spend quality time with the residents, although some residents said that the staff were always busy and they did not often see them to talk to properly. There are a number of very dependent people living at the home, and the owner and manager must make sure that staffing levels, training and guidance are such that both health care and social care needs are met. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 24 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 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is generally aware of areas that need to be improved in order to provide a service that more efficiently protects the health, welfare and safety of the residents. EVIDENCE: The registered manager has obtained the registered managers award, and also holds nursing qualifications. She has several years experience of care work, and of working in a supervisory capacity in care home environments. She has worked at this home for approximately 15 months, and been the registered manager for five months. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 25 The staff spoken to said they felt that the team worked well together and they worked in a very open atmosphere and were able to approach management easily. Staff meetings are held about once a month, where information and guidance is passed on, and staff can raise any issues they have. Management meetings are also held to discuss any requirements for the home and its residents. Residents meetings used to be held regularly, but the manager said that they had reduced, as residents were not interested. However residents spoken to said that they would like to speak to staff, and not all were clear on who the manager was. Advice was given on developing these meetings, and including relatives in them, to use as a place to help develop the service through discussion with the people who use it. It would also show that the manager is inclusive in her approach to managing the home, welcoming suggestions. The owner stated that there is a plan for the development of the home. There are no clear, recorded audits, or self monitoring, to show regular reviews take place on how the service is performing in delivering care tailored to the individual. The owner confirmed there is no involvement with personal finances, and invoices are issued for payments due on items such as the hairdresser or chiropodist. If family leave a small amount of money due to their absence for a while, records and signatures are kept. Records seen were generally up to date. Recording systems are improving, but records need to show more clarity in what individual care is planned in the areas covered for each person in their assessment. For example, how a person’s social contact is to be addressed, or how chosen daily routines are to be addressed, such as the time to get up and go to bed, toileting, and bathing needs. The reviews should address any changes in these, and any changes in the way staff are to carry out the tasks. The manager had recorded that the equipment used in the home had been correctly serviced or tested as required. Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 26 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 1 2 1 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 4(1) 5(1)(a) Requirement Information as stated in Schedule 1 must be in the Statement of Purpose and Service User Guide made available to residents and families. Resident’s needs must be assessed prior to admission to ensure the home can meet their needs. The reviews of resident’s care plans must be dependent on circumstances, and revisions made where records of falls or medical treatment prompt the need to adjust the way care is provided. Reviews must include the psychological health of residents where needed. There must be a regular activities programme in and outside the home for residents to be given opportunities for stimulation, which suits their needs and preferences. The environment must be improved to eliminate risks to the health and safety of the residents, and make it a pleasant DS0000063455.V340292.R01.S.doc Timescale for action 08/09/07 2 OP3 14(1) 14/08/07 3 OP8 12(1), 13(1), 14(1)(2), 17(1)(a) 14/08/07 4 OP12 16(2) 08/09/07 5 OP19 OP24 13(4)(c), 23 (2)(b) 30/11/07 Palmtree Lodge Version 5.2 Page 28 and homely place to live. Maintenance records must be kept up to date. Furnishings and fittings in the home must be improved to be of a good standard to meet the needs of the residents. Lighting must be domestic and homely and suitable for residents. 6 OP25 13(4) The water temperature as delivered to residents must be around 43 degrees centigrade to protect against scalding. The environment must be kept clean and free from any odours. The laundry room must be readily cleanable, and laundry systems must be efficient and protect against infection Full recruitment checks must be made for each new employee prior to them starting work at the home. There must be formal internal audits and reviews of the quality of care provided to residents, including consultations with residents and their representatives. Development plans must be based on the outcomes for individuals living at the home. The manager must at all times make arrangements to protect the residents health and welfare, through preventing poor environmental conditions, carrying out practical person centred planning reviews of people living at the home, and by providing responsible leadership to staff. 14/08/07 7 OP26 16(2) 23(1) 13(3) 14/08/07 8 OP29 19(1) 14/08/07 9 OP33 24(1) 30/09/07 10 OP38 13(3)(4) 30/09/07 Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 29 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 OP10 OP14 OP27 Good Practice Recommendations The manager should ensure staff know how to treat residents with respect at all times A record should be made of each residents’ personal possessions brought to the home. The manager should ensure staff are deployed in the best way possible to provide care to the residents, and contact with the residents, addressing both physical and social care. Accident records should be available in such a way that they are able to show any clear patterns of risk which need to addressed 4 OP38 Palmtree Lodge DS0000063455.V340292.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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