CARE HOMES FOR OLDER PEOPLE
Philia Lodge Rest Home 113-115 Eastfield Road Peterborough PE1 4AU Lead Inspector
Dragan Cvejic Key Unannounced Inspection 22nd September 2006 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 Philia Lodge Rest Home DS0000064347.V313026.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. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Philia Lodge Rest Home Address 113-115 Eastfield Road Peterborough PE1 4AU 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) 01733 567758 01733 561353 Care Provision Healthcare Ltd Mr John Frank-Onyejuba Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Philia Lodge provides care, support and accommodation for up to thirteen older people. The home is close to the centre of Peterborough; accommodation is provided in two houses which have been linked together and adapted to provide suitable accommodation for older people. The home has eleven single bedrooms and one double bedroom; four of the rooms are on the ground floor, the remainder are on the first floor, which is accessed by stairs or a spacious shaft lift. Communal areas consist of two lounges, a dining room, and a seating area in the large hallway. Residents also have access to a well-maintained garden to the rear, which is enclosed, and secure. The home primarily accommodates service users that belong to the Jehovah’s Witnesses faith. All but one member of staff belong to the same faith group. The fee was in the range £343.19 to £367.92. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The site visit happened in the morning hours and lasted for 6 hours. Requirements set previously were checked with the manager. Case tracking was the main methodology for this inspection and one service user was fully case tracked, while two others were partly case tracked. The manager and the director, who was also the responsible individual, spoke to the inspector and provided evidence to justify judgements for this report. A tour of the building and some general document reading was also used to collect evidence for the judgements about the standard of service. One staff member provided her opinion about the company and the home, and the maintenance man talked about the environment and the premises. The comments collected from external professionals for the purpose of quality assurance review were also used to inform judgements about the home. What the service does well: What has improved since the last inspection?
Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 6 The proprietor and the manager had updated the statement of purpose. The home was in the process of introducing a new computer system that would connect the home and head office. This system would bring benefits to the recording system, but also could improve the timing of responses to service users needs, as the director would have direct access. The monitoring system would also be improved with these electronic records. The contracts now contained the room number which service users were admitted into. The complaint procedure was updated to show accurate information. Maintenance work was carried out as required on the previous inspection. Staff files now contained photos. 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. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users were given accurate and well organised information about the home enabling them to make an informed choice. The assessment for each individual was detailed and equipped the home with all the necessary information to decide if the prospective user’s needs could be met. EVIDENCE: The home provided all the information about services and provisions in a combined manner in the statement of purpose, service user’s guide and the home’s brochure. The service user’s guide was available in large print. The statement of purpose was reviewed and kept up to date. Service users’ contracts were reviewed and the room number was added. Assessment details were sufficient and were used as a base to create care plans. Service users spoken to confirmed that their needs were met. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans need to be transferred and extended to the new format to clearly illustrate all service users’ needs and to include a full risk assessment, and be regularly reviewed for all service users. Controlled medication needed to be recorded according to Department of Health regulations to ensure better protection of service users. EVIDENCE: Care plans were drawn up from the initial assessment. The form for plans was short and concise. A new suggested format that was used for some, but not yet for all service users, was better, and reminded the creators of plans to record a wider range of needs for individuals. Some checked care plans were regularly reviewed, but some were not. Individual risk assessments were basic and focused on mobility and physical needs, but did not address all associated risks, such as poor eyesight, or risks associated with a broken arm for a service user. However, the staff were fully aware of users’ needs and knew who needed what at any particular time. An example was seen when a staff member went
Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 10 to offer breakfast in the room of the service user with a broken arm, to reduce the risk of a potential fall. The home had charts to monitor users’ weight and take action if necessary when significant changes occur. A service user commented on good equipment: “I am so pleased with this folding walking trolley, I can manage myself thanks to it.” Medication process was appropriate. Observed administration and the procedure demonstrated that the process ensured safety for service users. The home had accurate records for some controlled drugs, but one controlled medication was not treated as such, and needed to be included with medication that required enhanced recording with two signatures. Privacy and dignity were highly respected within the home and service users felt respected as individuals. They were addressed by the name they wanted and with religious rules that they wanted. Service users used the same religious customs to address staff. The respect for users’ religious beliefs and individuality exceeded the standard addressing privacy and dignity. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users autonomy, independence and wishes were respected and promoted. EVIDENCE: The home provided a structured and organised daily routine for service users. A weekly programme was displayed in the hall. A service user with a broken arm decided to have a breakfast in her room, as advised by a carer, to prevent any potential falls. Another user was proud of being mobile with a folding trolley, a walking aid that made her feel safe and independent. The home provided not only a payphone for service users, but also short and clear instructions that allowed even those with some confusion problems to use the phone. Some religious books, obviously liked by service users, were available in the hall. The provider offered a religious service 3 times a week, to the users’ satisfaction. A service user commented: “This home is a godsend. The food is very good, we have choice, they provide what we want and we are not hurried to eat. They take us shopping on Fridays and activities are good.” The home kept close contacts with other Jehovah’s witnesses organisations. Service users autonomy and choice were promoted. The home made a list of
Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 12 service users’ possessions on their entry to the home. However, these lists were not signed. Meals were organised in a way the service users liked. They were observed during breakfast and lunch and the atmosphere in the dining room was pleasant and friendly. Care staff were preparing food, but the provider explained that with the planned increased number of bedrooms and service users, consideration would be given to employing kitchen staff. A menu was also displayed and explained to service users what the planned meals were. When a service user wanted to eat in her room, the staff served breakfast there for her. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An effective and accessible procedure was in place to protect service users through safe working practices. EVIDENCE: The provider had reviewed and expanded the home’s complaint procedure since the last inspection. Although it now contained all required elements, it needed another up-date to show accurately the role of the CSCI in the process. The procedure was displayed and available to service users, visitors and staff. The home had not received any complaints since the last inspection. The home had the policies and procedures in place that ensured protection of service users. The staff spoken to stated that they knew their role in a potential complaints procedure. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was suitable for service users and was arranged in the way they wanted with religious symbols. A maintenance programme should help improve the safety further regarding the closing of fire doors. EVIDENCE: The tour of the home and service users’ comments demonstrated that the home was suitable for service users and met their expectations in relation to the environment. The home was decorated with religious symbols and clearly pictured the users’ faith and view on life. The home employed a maintenance man who was present whenever it was necessary, but, therefore, did not have a programme of routine maintenance. Closing a fire door was addressed on the previous inspection. It was readjusted. As the weather changed and wooden doors reacted to the level of humidity, the problem reoccurred. When identified during the site visit, the maintenance man adjusted the door again. However, it was suggested and
Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 15 agreed that a programme for routine checking of the doors within the home was necessary to ensure continuous safety at any time. Adding a lock to a bedroom door and replacement of the carpet in one bedroom was carried out as required on previous inspection. The home was clean and bright and infection control measures were in place. The owner and staff mentioned that, with the planned expansion, the employment of regular cleaning staff would be considered. The laundry flooring was covered with a special coat to improve hygiene. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was considering the service users’ needs when the staffing level was decided and the recruitment process was initiated when there was a need to employ more staff. Staff were well trained, belonged to the same faith group as service users and were able to show respect for service users religious needs. EVIDENCE: The home employed staff with the same religious orientation. Only one staff member did not belong to the Jehovah’s Witness faith. This helped staff better understand the needs, preferences and views of service users. This fact was a positive element of equal opportunities in the home where all service users belonged to the same faith. Although the full staff complement was achieved, the provider considered expanding the staff team even before the new extension and the expansion of the home was completed. Meanwhile, the home used their own bank staff to cover absences, ensuring consistency and continuing to respect religious balance. Two staff were present on each shift and the management was supernumery with the responsible individual stepping in 3 times weekly for activities and religious sessions. The home employed some staff for very few hours, in one case only 7 hours per week. However, there were 7 full time staff at the time of the site visit who had all attended NVQ training.
Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 17 Some training certificates were displayed showing attendance for all mandatory subjects and a 3 day course in dementia. Staff spoken to confirmed that training offered was very good. The home benefited from the training provided in the sister organisation, across the road, that accepted staff from the home attending training free of charge. Two staff files showed differences in how they were organised. One contained a CRB disclosure and the other did not. The home was in the process of setting up a new computerised system to keep the staff records and to unify the content. The system was shown to the inspector. Despite the missing CRB disclosure the requirement was not set at this time, but when the new system begins operating, this standard would need to be checked again. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensured the safety and welfare of service users. The safe working practices were in place. EVIDENCE: The home was managed by the registered manager, a skilled and experienced person that belonged to the same faith group. He was well supported by the director of the company and the responsible individual, as titled by the CSCI. The responsible individual also provided a religious service 3 times a week, meeting the needs and wishes of service users. The staff team was relatively stable with a very small turnover. This ensured consistency of service for users, but also was the base for support and care, while care plans contained only a short description of users’ needs. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 19 The organisation carried out a quality assurance review. All service users, staff and 7 external professionals filled in survey questionnaires and the management team was reviewing the results to create an action plan. Several service users held their money or personal allowances. Valuables belonging to service users were recorded. Staff were trained and the home had clear safe working practices in place. Moving and handling procedures were monitored in order to constantly improve safety for service users. Accidents/incidents were recorded accurately. Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 13,15 Requirement Service users’ care plans must address all areas of needs, be reviewed regularly and contain a risk assessment that addresses all potential risks for each individual. The home must include all controlled drugs on the controlled drugs register and ensure that records of administration of them is signed by two staff. Staff files must contain all of the information required. This is a requirement set previously with the time scale 31/12/05. Now an extended time scale is set, while the home finishes introducing the new computer system that will ensure that staff files are complete. Timescale for action 15/12/06 2. OP9 13 30/11/06 3. OP29 19 & Schedule 4.6 31/12/06 Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP14 OP16 Good Practice Recommendations The lists of service users’ possessions should be signed by service users or their representatives. Although the complaints procedure was reviewed since the last inspection, the change in the responsibility for investigation of complaints was changed in relation to the CSCI and this element should be incorporated into the procedure. The maintenance man should produce a programme for regular routine maintenance of the doors, in particular fire doors, to ensure the home was safe at any time and complied with fire regulations all the time. 3 OP19 Philia Lodge Rest Home DS0000064347.V313026.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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