Inspection on 05/06/06 for Preston Lodge

This inspection was carried out on 5th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Preston Lodge 29/09/08

Preston Lodge 18/10/07

Preston Lodge 01/02/06

Preston Lodge 15/08/05

Preston Lodge 16/03/05

Preston Lodge 18/05/04

Similar services:

Spinney (The)

Queen Elizabeth House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Preston Lodge 291 Preston Road Harrow Middlesex HA3 0QQ Lead Inspector Richard Adkin Key Unannounced Inspection 5th June 2006 08:00 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 Preston Lodge DS0000017481.V297564.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. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Preston Lodge Address 291 Preston Road Harrow Middlesex HA3 0QQ 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) 020 8904 2866 020 8621 1788 Mrs Juliette Taylor Mrs Juliette Taylor Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (6) of places Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: Preston Lodge is registered to provide accommodation and care support to 6 elderly people. The home is a semi-detached property located on a main road. It has two floors and an attic flat. There is also an electric wheel chair lift that takes resident who are wheel chair users to the bedrooms on the first floor. All of the bedrooms except one are single occupancy with washbasins. One bedroom is shared by two residents. The home is within easy access to public transport services and local shopping with health and social care facilities and services within easy reach of the home. The home is owned and managed by the registered manager. At the time of this inspection, the duty rota recorded that nine staff worked at the home. There is one waking night staff. Entrance to the home is accessible by wheel chair users and there is off street parking spaces at the forecourt of the home. The rate of charges for the care home is £450.00 per week. Currently there are five residents at the home with a further service user receiving care during the day. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Unannounced inspection was made on a weekday morning and lasted five hours. The purpose of the inspection was to look at the core national minimum standards and the requirements that arose at the previous inspection. Opportunity was afforded for the Inspector to meet the five residents and the shift leader, one care staff and the cleaner, to look at relevant policies and procedures and care staff record and to look around the premises. The Inspector would like to thank the shift leader and care staff and residents for their contribution to the inspection. One immediate requirement arose during the inspection concerning fire safety. What the service does well: What has improved since the last inspection? What they could do better: New residents moving in to the care home must have more comprehensive assessment of needs and risks in place. The home needs to develop a process for capturing complaints and compliments, as this is not in place. Only two members of staff are trained in giving medication, namely the manager and the deputy. This shortage needs to be addressed as a matter of urgency. Upgrading of areas like the kitchen and safe access to the back garden remain outstanding pieces of work that need to happen. CSCI must be informed of significant incidents that occur and have occurred at the home, as there were gaps in reporting. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 6 Staff meetings are taking place, but a record needs to be kept of what was discussed and who attended. The manager needs to ensure that requisite electrical testing and certificates are up to date. An immediate requirement was made as the records on fire drills; fire tests and related areas were not up to date and were not currently happening. 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. Preston Lodge DS0000017481.V297564.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 Preston Lodge DS0000017481.V297564.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): 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. A comprehensive assessment of needs for new residents must be in place to ensure that the needs of new residents are met. EVIDENCE: The care notes of the most recent resident to come to the care home several weeks previously, were looked at by the Inspector. The service users’ ‘pre-admission assessment sheet’ was completed for the resident covering preferred means of address, mobility personal care, medication, health needs, dietary needs. Given the complexity of the residents’ needs, the assessment and care plan contained limited information from referring agencies, falling below what would be expected. Other residents’ files looked at however, contained necessary information that had contributed to the development of relevant care plans. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 9 Intermediate care is not provided at the care home, but respite care is provided. One person attend the care home daily for day care; this service user lives nearby with her son who brings her to the home when he goes to work. There is a risk assessment in place for this person who attends daily. Several service users have attended for day care at Preston Lodge in the past few years. There is documentary evidence that several service users in the past few years have made use of the care home as a day care facility. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Medication training is needed for more members of staff. Care workers treat residents with respect and warmth. EVIDENCE: At the previous inspection it arose that the manager had to ensure that when medication was refused by residents or not given the reasons for refusal must be recorded on the MAR sheet. Part of this requirement was that all staff with responsibility for the administration of medication should receive up to date training in the area of refusal of medication. Residents had not been refusing medication, though one resident sometimes needs encouragement. Only two members of staff were authorised signatories and had had up to date training, namely the manager and the deputy. The number of trained staff to provide medication must be increased to provide flexibility and necessary cover in the giving of medication. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 11 The Boots monitored dosage system is in place. The MAR records looked at were satisfactory. The personal care files of two established residents look at by the Inspector were clearly laid out with personal profile, daily records, assessment, record of reviews, medical records and finances. Medical records looked at were up to date. Residents were observed by the Inspector to be treated with respect and warmth by the care staff. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Residents chosen lifestyles are supported by care staff in a homely atmosphere. Appealing food is served. Strong links are made with local religious institutions. EVIDENCE: During the course of the inspection four residents received Holy Communion from a representative from the local church. Another resident attends a different local church. Another resident attends a different local church. An activity programme was displayed in the dining room. One resident spoke positively of her lifestyle at the care home. She felt that she was supported sensitively in going out for walks locally by care staff at the home. This resident felt it was ‘home from home’. She enjoyed reading her paper that she received daily and having eh opportunity to selectively watch television. She felt that her family were made welcome in visiting her. There was evidence in the visitors’ book of residents having regular visits from family and friends. One resident received a visit from a friend during the Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 13 course of the inspection. The friend gave positive feedback on the care of her friend and how she herself was received. Lunch was served during the course of the inspection. Some positive comments were received from residents about the quality and choice of food. The food looked wholesome and nutritious. Residents were given drinks regularly. A good selection of fruit was available in the fruit bowl in the kitchen. Cut fresh fruit was served to residents in the afternoon. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 14 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 adequate. This judgement has been made using available evidence, including a visit to this service. Complaints and compliments need to be captured. Personnel procedures are satisfactorily in place. EVIDENCE: A requirement that arose at the previous inspection linked to Standard 29 that the manager of the care home needed to ensure that all references, including CRB checks for staff are up to date and available for inspection. Two personnel files were looked at by the Inspector; references and CRB checks were all in place and were satisfactory. The complaints procedure is displayed in laminated form by the front door and the brief policy is in the Policies and Procedures file. There was no complaints file in place as no complaints had been received about the care home. Likewise, there was no way of receiving compliments concerning the care that residents had received. A system and process must be in place the capture compliments and complaints made about the care home. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 15 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, 20, 25, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Some maintenance work remains need to be undertaken. Electrical testing is required. The home is clean and hygienic. EVIDENCE: Three requirements arose at the previous inspection (1st February 2006), concerning the home’s environment. Firstly, the manager had to ensure that the external areas of the home, including access to the garden and pavement are made safe and in good state for use by the residents, staff and visitors. Secondly, the manager had to ensure that repairs and upgrading of the kitchen, staff room and other areas are carried out to help improve the overall physical condition of the home. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 16 Thirdly, the manager needed to ensure that the required electrical testing and certification are carried out. Access to the back of the home remains unsatisfactory and needs rectifying to ensure that the surface is safe and in a good state of repairs. The front and the back garden themselves are attractive upgrading of the home needs to take place, particularly in the kitchen area. In the kitchen areas there was a damaged table that needs replacing. The casing for the boiler was coming away and this needs securing. Electrical testing was due to take place. The electrical contractor was due to visit the following week. The toaster was last tested April 2003, this certificate was awaited. This information must be passed to CSCI at the earliest opportunity. The home was clean throughout and free of offensive odours. The cleaner was busy throughout the inspection, cleaning the premises. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 17 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. Risk assessments are in place for residents. Staff are supervised. The home’s recruitment policy and practices are satisfactory. EVIDENCE: As raised with Standard 18, the requirement that arose previously was that the manager of the care home needed to ensure that CRB checks are in place, along with two references, which were all in place. Thus protecting residents An issue that arose around the lack of trained medication givers at the care home that was addressed in Standard 9. Risk assessments, (except for the most recent residents), were detailed in care records looked at and ensured that the moving and handling of residents was considered and acted upon. Evidence was seen in staff files of supervision taking place and being recorded. Supervision notes addressed the training needs of staff members. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 18 Staff members spoken to were positive about opportunities offered in the way of training, particularly NVQ training – the lack of training around medication is noted previously. Staff meetings take place every three weeks or so, but are not formally recorded which should be happening. Items discussed should be recorded, along with those care staff who attended. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 19 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, 34, 35, 38 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The quality of service and care of residents was experienced by residents and observed to be good The lack of fire checks was unsatisfactory, as was the lack of notification of significant incidents to CSCI. EVIDENCE: A requirement that arose at the previous inspection was that the manager must keep the Commission for Social Care Inspection updated regarding the home’s financial viability, but this has not taken place and remains a requirement. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 20 It was observed by the Inspector of a climate of residents being engaged in a meaningful way by staff on duty at the home. Though the manager had just gone off duty, there was a sense of purpose in the delivery of care. A regulation 37 notification had been received for one resident who had died in January 2006, but no notification for a resident who passed away at the end of 2005 and no notification was received for a resident who died in April 2006, having spent some time in hospital. The last internal fire check carried out by the home was 27/1/06 and this was not complete. The last fire alarm test recorded was December 2005; there was no evidence of fire drills. It was an immediate requirement to address fire systems, i.e., the records of fire drills and fire tests must be kept up to date and must take place regularly. Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 x 2 2 X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 2 3 X 2 1 Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) Requirement A comprehensive assessment of need must be in place for the most recent resident who moved into the care home More members of staff must be trained in giving medication to ensure flexibility and comprehensiveness in medication giving. A system and process for capturing compliments and complaints must be developed. The manager must ensure that repairs and upgrading of the kitchen, staff room and other areas are carried out to help improve the overall physical condition of the home. (Previous timescale of 30/06/06 not met) The manager must ensure that the external areas of the home, including access to the garden and pavements are made safe and in good state for use by the residents, staff and visitors. (Previous timescale of DS0000017481.V297564.R01.S.doc Timescale for action 01/08/06 2. OP9 18(1) 01/09/06 3. OP16 22 01/09/06 4. OP19 23(2) 01/09/06 5. OP20 13(4) 01/09/06 Preston Lodge Version 5.2 Page 23 30/5/06 not met) 6. OP25 13(4) The manager must ensure that the required electrical testing and certification are carried out. A copy of this must be sent to CSCI) (Previous timescale of 30/5/06 not met) Staff meetings must be recorded. The manager must keep the Commission for Social Care Inspection updated regarding the home’s financial viability. (Previous timescale of 30/4/06 not met) CSCI must receive Regulation 37 notification of all significant incidents. CSCI must receive retrospective notifications of the death of two residents in the last eight months. The records of fire drills and fire tests must be kept up to date and must take place regularly. 01/07/06 7. 8. OP30 OP34 17 25 01/07/06 01/08/06 9. 10. OP37 OP37 37(a) 37(a) 05/06/06 01/07/06 11. OP38 17 05/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Preston Lodge DS0000017481.V297564.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 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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