CARE HOMES FOR OLDER PEOPLE
Primrose Lodge 42 St Catherines Road Southbourne Bournemouth Dorset BH6 4AD Lead Inspector
Marjorie Richards Key Unannounced Inspection 1st September 2006 10:45 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 DS0000063469.V305352.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. DS0000063469.V305352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Primrose Lodge Address 42 St Catherines Road Southbourne Bournemouth Dorset BH6 4AD 01202 429514 01202 429514 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) Primula Care Limited Mrs Deborah Louise Mitchell Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places DS0000063469.V305352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. Mrs Mitchell must obtain an NVQ level 4 in management and care by August 2007 and evidence of successful completion must be forwarded to the Commission. Within the total of 27 places, two service users may be accommodated within Primrose Lodge over the age of 50. 9th November 2005 Date of last inspection Brief Description of the Service: Primrose Lodge is a large, converted Edwardian property, situated in a residential area of Southbourne in Bournemouth. Local shops are within level walking distance and cliff-top walks about half a mile from the home. The main shopping area of Southbourne, with all its amenities, is less than one mile away. Bus services are available close by to all parts of Bournemouth, Christchurch and beyond. The property is approached via a driveway with a parking area for visitors. Additional parking is available on nearby roads. Primrose Lodge is registered to accommodate up to 27 older persons. The accommodation is arranged over three floors, with a two-person passenger lift to aid access between the floors. There are four double bedrooms (used as singles unless two residents choose to share) and nineteen single rooms. All bedrooms, with the exception of one, have en-suite facilities. The lounge and separate dining room are situated on the ground floor. The lounge overlooks the attractive front garden and the dining room looks out over the rear garden, laid mainly to lawn with mature trees and shrubs and a paved patio area. Twenty-four hour care is provided. Laundering of personal clothing etc is carried out on the premises. All meals are prepared and cooked within the home. A choice of menu is offered for the lunchtime meal and a variety of alternatives are available to suit individual taste and preference. Activities are available six days a week, to provide stimulation and interest for residents. The current range of fees is as follows: -£354 - £528 per week. Hairdressing, chiropody, newspapers, dry-cleaning and personal toiletries are charged extra.
DS0000063469.V305352.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8.25 hours on the 1st September 2006. The purpose of this year’s first key unannounced inspection was to review all of the key National Minimum Standards, review progress in meeting the requirements and recommendations that had been made at the previous inspection and to ensure that the residents living at Primrose Lodge were safe and properly cared for. A tour of the premises took place and records and related documentation were examined, including the care records for three residents. Time was spent observing the interaction between residents and staff, as well as talking with ten residents. The daily routine was also observed during the inspection. Discussion also took place with Mrs Debbie Mitchell, the registered manager and members of staff on duty. Mr Graham Thomas made himself available for most of the inspection, on behalf of Primula Care Ltd, and this was appreciated. Pre-inspection information had been completed and submitted before the inspection. In addition, the Commission received twenty-six completed comment cards from residents and relatives and one from a General Practitioner. All expressed general satisfaction with the care provided. For the purposes of this report, people who live at Primrose Lodge are referred to as residents as this is the term generally used within the care home. The Inspector was made to feel very welcome in the home throughout the visit. What the service does well:
The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities. Copies are provided in every residents bedroom. An Information File is placed in the entrance hall at Primrose Lodge, where a copy of the current inspection report is available. This file contains further information about the services available in the home, as well as sample menus and the results of Quality Assurance surveys in the home. All residents at Primrose Lodge are issued with terms and conditions of residence. The resident or their representative and the registered provider sign these and retain a copy and a copy is held on file. DS0000063469.V305352.R01.S.doc Version 5.2 Page 6 Individual care records confirm that, prior to moving to Primrose Lodge, care needs have been fully assessed. A comprehensive form has been developed for this purpose. Mrs Mitchell generally carries out pre-admission assessments herself. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs will be met. Health care needs are well met, with evidence of good support from community health professionals, such as General Practitioners, District Nurses, chiropodists, opticians etc. The arrangements for storing and handling medicines in the home ensure residents’ safety. Staff were observed throughout the inspection to be treating residents with courtesy, kindness and respect. Residents commented, The staff here are generally very good. They give old people the respect they deserve.” It is nice here, the staff are very good to me. They are always polite. A range of activities and entertainment provides variation and interest for residents. Suggestions made by residents, including quizzes, manicures and bingo, have been acted upon and are now taking place on a regular basis. Entertainment is also arranged and gentle exercise to music sessions are held on a weekly basis. All events and activities are detailed on the notice board in the dining room. Open visiting arrangements are in place, so residents are able to maintain contact with visitors as they wish. A resident commented, “I can have visitors whenever I want. The staff always make us a cup of tea.” As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirmed that their individual preferences and routines are respected. I decide what I want to do all day long. At my age, I often don’t want to do very much, but if I do want to join in something, then I can do so. Primrose Lodge serves a balanced and varied selection of food that meets residents’ tastes and dietary needs within pleasant surroundings. If residents do not want what is on the menu, then a range of alternatives, such as jacket potatoes with a variety of toppings, omelettes, salads etc is always available to suit individual taste and preference. Residents may choose to eat their meals in the lounge, dining room or in their bedrooms. Mealtimes can be flexible to fit in with care needs, appointments etc. Special diets are catered for and the menu shows that residents enjoy a healthy, well-balanced diet. Many residents commented favourably about the food. I think we are very fortunate to have such a good cook. I enjoy all my meals. The food always looks and smells appetising. Even when I am not very hungry, I always
DS0000063469.V305352.R01.S.doc Version 5.2 Page 7 manage to eat more than I thought possible.” We have lovely meals here. There is always a good choice on the menu. A system is in place for dealing with any complaints. Discussion with residents demonstrated they would feel able to voice a complaint if necessary and their concerns would be taken seriously, and acted upon. Comments included: “I have no complaints at all, I am very satisfied with everything here.” I have never had to make a complaint. If I have any concerns I tell Debbie, (manager) and she deals with it.” The home has a comprehensive Adult Protection policy in place to ensure residents are protected from possible abuse. Staff have received training to ensure a proper response to any allegation of abuse. The programme of refurbishment and redecoration is continuing, so that residents live in comfortable and well-maintained surroundings, where standards are constantly improving. Primrose Lodge has a lounge and separate dining room. These adjoining rooms are attractively presented and furnishings are good quality and domestic in character. The garden areas are, in the main, accessible to wheelchair users. Garden seating and patio furniture is available to residents wishing to sit outside. Bedrooms are comfortably furnished and personalised to varying degrees. Primrose Lodge is registered to accommodate up to 27 residents in 4 double and 19 single bedrooms. However, the home has a policy, which states that only those who wish to share will be accommodated in a double room. At present, 3 of the 4 double rooms are used for single occupancy. Residents commented, “I like my room very much. Everything is new and I think it looks lovely.” My room is very comfortable and I have a lovely view over the garden. Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the current needs of residents. Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were seen to be responding to needs appropriately and undertaking good care practice, demonstrating a caring, gentle approach when dealing with residents. Residents said, Everyone here is brilliant, they have looked after me very well.” The staff are very kind. I have not wanted for anything. The staff files examined demonstrate that the home is operating a thorough recruitment procedure, with all necessary documentation is in place to ensure the protection of residents. DS0000063469.V305352.R01.S.doc Version 5.2 Page 8 The home takes staff training seriously as a means of improving the standard of care provided and ensuring residents safety. All new staff receive suitable induction training. Since the last inspection, an audit of staff training has been carried out and a document produced which clearly identifies the training achieved by all staff in the home and where further input is needed. Staff commented, We do a lot of training here, which is really helpful. “Primrose Lodge is a good place to work. I have learned a lot since coming here.” Mrs Mitchell demonstrates a good knowledge of the operation of the care home and the needs of its residents. Mrs Mitchell describes herself as a very “handson” manager and feels it is important to remain open and accessible to residents, visitors and staff. This was demonstrated throughout the inspection. Mrs Mitchell says she always feels well supported by the registered provider, Primula Care Ltd. Residents spoke highly of the manager: “The manager is lovely, very kind. You can tell her anything.” “The manager is sweet. I enjoy talking with her.” “She is someone who listens to what you are saying Staff also commented: “Debbie is very supportive. You can talk to her and she understands where you are coming from.” “She is very good, very fair.” Quality Assurance questionnaires have been sent out to residents, staff, relatives and other visitors to the home to obtain their views. Feedback from these is available in the Information File in the entrance hall. In order to protect residents, the home prefers to have no involvement in personal finances. At present, the home pays for services such as chiropody and hairdressing and keeps a record of what is owed. This amount is then invoiced to relatives or representatives for payment. Examination of supervision records shows that care staff are now receiving formal supervision at least six times a year, as a means of ensuring good practice and looking at individual career development needs etc. Measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, alarm call system, hoists etc are regularly serviced and maintained. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Staff fire training and fire drills ensure that staff are fully aware of the action to take in the event of a fire. DS0000063469.V305352.R01.S.doc Version 5.2 Page 9 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000063469.V305352.R01.S.doc Version 5.2 Page 10 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 DS0000063469.V305352.R01.S.doc Version 5.2 Page 11 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 and 3 Standard 6 is not applicable at Primrose Lodge Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to Primrose Lodge. Information provided about Primrose Lodge and a thorough admissions procedure allows prospective residents to make informed decisions about admission to the home and ensures that only those whose needs can be met are offered places there. The home assures prospective residents in writing that their needs can be met. EVIDENCE: The Statement of Purpose and Service User Guide contain all of the information required about the home and its facilities. The Service User Guide gives a good indication of what a resident can expect from the home and includes details of the complaints procedure and a Quality Assurance questionnaire. All of these documents are provided in every residents bedroom. They are also included in an Information File placed in the entrance hall at Primrose Lodge, where a copy of the current inspection report is
DS0000063469.V305352.R01.S.doc Version 5.2 Page 12 available. Mrs Mitchell has recently updated and expanded this file to include photographs and further details, e.g., about the services available in the home, such as hairdressing, chiropody, opticians and dentists. Information is also provided about menus, advocacy services for those requiring independent advice and support and the results of Quality Assurance surveys in the home, with analysis and an action plan. All of the information is provided in an easy to read format and in large print. Mrs Mitchell is currently working to produce a separate Service User Guide for those residents coming to the home for respite or short–term care. All residents at Primrose Lodge are issued with terms and conditions of residence. The resident or their representative and the registered provider sign these. The resident and/or their representative retain a copy and a copy is held on file. A further blank copy of the terms and conditions is in the Service User Guide, which is available in every bedroom and in the Information File in the entrance hall. Minor amendments recommended following the last inspection have been completed. Individual care records are kept for each resident and three of these were examined. They confirmed that, prior to moving to Primrose Lodge, care needs had been fully assessed. A comprehensive form has been developed for this purpose. Mrs Mitchell generally carries out pre-admission assessments herself. A letter of confirmation is then written to the prospective resident so that they may feel assured their care needs will be met. The information contained in pre-admission assessments and also any assessments supplied by Social Services, is then used to draw up a detailed plan of care. DS0000063469.V305352.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Primrose Lodge. Primrose Lodge has a good care planning system in place, but more attention to detail must be taken to ensure that staff always have the information they need to meet the needs of residents. Health care needs are well met, with evidence of good support from community health professionals. The arrangements for storing and handling medicines in the home ensure residents’ safety. Residents are treated respectfully and care is offered in a way that protects their right to privacy and dignity. EVIDENCE: Two of the care plans examined were based upon information provided from pre-admission assessments undertaken by Mrs Mitchell and a third care plan, completed before Mrs Mitchell was appointed as manager, was based upon
DS0000063469.V305352.R01.S.doc Version 5.2 Page 14 information provided by the Local Authority. Following assessment, the home draws up its own care plan identifying the needs of each resident and how staff are to meet these needs. In general, care plans are well laid out and well maintained. Mrs Mitchell is now seeking to involve residents or their representatives in care planning and review wherever possible. Occasionally, care plans make general statements, for example, “Legs needs creaming,” without being specific about the interventions needed from staff, the type of cream to use etc. One preadmission assessment identified that the resident had lost weight before entering the care home, but this information had not been translated into a nutritional care plan. Care plans are regularly reviewed, at least monthly but not always updated as necessary to reflect any changing needs. On one of the files examined, the visit by a District Nurse had been recorded in detail, but her advice for further treatment had not been transferred to the care plan. However, a visit to the resident’s room evidenced that staff were following the advice given by the District Nurse, having been informed verbally. Good daily records are written by both day and night staff to evidence the care being provided. Discussions with staff demonstrated that they had a good knowledge of residents’ individual care needs. The home has systems in place for managing medicines. Observation of the staff administering medication and examination of the records indicate that medicines are given as prescribed, to ensure the protection of residents. Staff were seen to knock at bedroom doors and to offer personal care discreetly. Staff interacted with residents in a friendly and caring manner. It was clear from the time spent with residents that they felt comfortable and at ease with staff. Staff were seen throughout the inspection to be treating residents with courtesy, kindness and respect. Residents commented, The staff here are generally very good. They give old people the respect they deserve.” It is nice here; the staff are very good to me. They are always polite. Only those residents who have expressed a wish to share, occupy the double bedrooms. (These rooms are often used only for single occupancy.) Residents confirm that they are able to go to their own bedrooms whenever they wish, thereby offering an opportunity to be on their own or allowing privacy for any visitors or personal care needs. Residents commented, I like to go to my room and watch the television or read my paper.” I spend most of my time in my own room. That is my choice.” “Sometimes I like to join in with the activities, but I often prefer my own company and like to stay in my room. DS0000063469.V305352.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Primrose Lodge. A range of activities and entertainment provides variation and interest for residents. Open visiting arrangements are in place, so residents are able to maintain contact with visitors as they wish. Residents are encouraged to choose their own lifestyle within the home and their individual preferences and routines are respected. Primrose Lodge serves a balanced and varied selection of food that meets residents’ tastes and dietary needs within pleasant surroundings. EVIDENCE: Of the 22 comment cards received from residents, in response to the question Does the home provide suitable activities? 12 residents said Always, 5 said Usually, 3 said Sometimes and 2 said Never. At the last inspection residents commented that the home had provided few meaningful activities for
DS0000063469.V305352.R01.S.doc Version 5.2 Page 16 some time. Mrs Mitchell has been making improvements with activities now available six days a week. Many more residents said during this inspection that they were pleased with the progress made and the activities now being provided. Suggestions made by residents, including quizzes, manicures and bingo, have been acted upon and are now taking place on a regular basis. Regular entertainment is also arranged and gentle exercise to music sessions are held on a weekly basis. All events and activities are detailed on the notice board in the dining room. A group of residents took pleasure in playing bingo in the lounge during the afternoon of the inspection and several residents also enjoyed having manicures carried out by staff. Residents commented, “I enjoy all the activities. The staff have worked very hard and now there is something on most days.” “I like to sit in my room on my own watching television. I am asked if I want to join in the activities and I do like having manicures and one-to-ones.” “It is better than it was, but some activities are of no interest to me. I would like to go on an outing sometimes, now that would be lovely.” “I like playing bingo, we have lots of fun.” Birthdays and other important events are commemorated in the home. Recently, a diamond wedding anniversary was celebrated and plans are now in hand for a resident’s 100th birthday party to take place shortly. At the last inspection, it was found that care plans contained very limited information about residents background, social history, previous hobbies and interests etc. Mrs Mitchell has now prepared life histories, which will help to ensure that the activities on offer at Primrose Lodge can be tailored to meet the individual needs, preferences and expectations of residents. Arrangements are made for clergy to visit individual residents upon request. Residents and staff confirm that visiting times at Primrose Lodge are unrestricted. A resident commented, “I can have visitors whenever I want. The staff always make us a cup of tea.” Residents records and the visitors book demonstrate contact with family and friends as well as visits by professionals. Some residents are able to go out of the home alone or with their visitors or with staff. A telephone is always available to residents. As far as possible, residents are encouraged to choose their own lifestyle within the home and make choices about how they wish to live. Residents confirmed that their decisions, for example to spend most of their time in their bedrooms, to go to bed early or late, were respected by staff. Residents are able to bring their own possessions into the home to personalise their bedrooms. Residents are encouraged to choose what to wear, what to eat or drink and have the freedom to come and go as they please. Residents confirmed that
DS0000063469.V305352.R01.S.doc Version 5.2 Page 17 their individual preferences and routines are respected. I decide what I want to do all day long. At my age, I often don’t want to do very much, but if I do want to join in something, then I can do so. They (staff) leave me alone to get on with my life, which is just how I like it. I know they are there if I need anything. Lunch on the day of inspection was fish, baked, poached or in batter, or ham, or eggs with chipped or creamed potatoes, peas and tomatoes. Pears and cream or choc-ice followed this. A range of alternatives, such as jacket potatoes with a variety of toppings, omelettes, salads etc is always available to suit individual taste and preference. A large bowl of fruit is also available in the dining room and residents may help themselves at any time. Staff were observed encouraging residents to eat fresh fruit during the day and assisting them with preparation where necessary. The evening meal was observed being prepared by the care staff, consisting of tomato soup and a variety of sandwiches, followed by fruit cocktail and cream or icecream. Residents may choose to eat their meals in the lounge, dining room or in their bedrooms. Mealtimes can be flexible to fit in with care needs, appointments etc. Special diets are catered for. The menu shows that residents enjoy a healthy, well-balanced diet. Good supplies of fresh, frozen, tinned and dry foods were available. Many residents commented favourably about the food. I think we are very fortunate to have such a good cook. I enjoy all my meals. The food always looks and smells appetising. Even when I am not very hungry, I always manage to eat more than I thought possible.” We have lovely meals here. There is always a good choice on the menu. Sometimes there is a bit too much on my plate. If you do not like what is on the menu, the chef will cook you something else. You cannot say fairer than that. “You can’t complain about the food, it is all very good.” At the last inspection, several residents pointed out that the menu board was not kept up-to-date and the chef sometimes assumed what they wanted to eat, rather than asking. No such concerns were raised on this occasion and it was noted that the menu board carried full details of the meals for the day. DS0000063469.V305352.R01.S.doc Version 5.2 Page 18 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Primrose Lodge. A system is in place for dealing with any complaints. Residents are confident complaints would be listened to and dealt with appropriately. The home has a comprehensive Adult Protection policy in place to ensure residents are protected from possible abuse. EVIDENCE: The home has a complaints policy and procedure that is included in the Service User Guide provided to all residents in their bedrooms. A copy of the complaints policy is also available to visitors in the Information File in the entrance hall. The complaints record shows that one complaint has been received by the home since Primula Care Ltd. was first registered in February 2005. This was investigated and appropriate action taken. Discussion with residents demonstrated they would feel able to voice a complaint if necessary and their concerns would be taken seriously, and acted upon. Comments included: “I have no complaints at all, I am very satisfied with everything here.” I have never had to make a complaint. If I have any concerns I tell Debbie, (manager) and she deals with it.” You can always talk with some of the staff or Debbie if you are worried about anything.” “I am happy with everything, no problems.”
DS0000063469.V305352.R01.S.doc Version 5.2 Page 19 The home has a comprehensive Adult Protection policy in place to protect residents from possible abuse. This makes reference to the Department of Health No Secrets document, which is also available to staff. Fourteen staff have now received Adult Protection training and further training is booked for the remaining two new employees. The staff on duty confirmed that they had received training in the Protection Of Vulnerable Adults and found it helpful and informative. DS0000063469.V305352.R01.S.doc Version 5.2 Page 20 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, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Primrose Lodge. The programme of refurbishment and redecoration continues, ensuring that residents live in comfortable and well-maintained surroundings, where standards are constantly improving. Residents have access to pleasant communal areas, including a large garden. Bedrooms are comfortably furnished and individually personalised to suit their occupants. Primrose Lodge is clean, but there is an unpleasant odour in one area of the home. Appropriate action is currently being arranged to deal with this, so that all residents live in a pleasant environment. DS0000063469.V305352.R01.S.doc Version 5.2 Page 21 EVIDENCE: A tour of the building demonstrated that further improvements are continuing to take place, as part of the refurbishment of the home. Thirteen bedrooms have now been completely refurbished; eight new windows have been fitted and a number of new commodes have been purchased. New crockery and towels have been provided and in the kitchen, a new refrigerator and deep fat fryer are in place. Records show that continual work is carried out to keep the home and garden in good condition, with a member of staff employed to carry out maintenance tasks. Care staff confirm that prompt attention is always paid to any defects. Hot water temperatures at baths were tested and found to be close to the recommended temperature of 43C, to prevent any risk of scalding. Primrose Lodge has a lounge and separate dining room. These adjoining rooms are attractively presented. Furnishings are good quality and domestic in character. The garden areas are, in the main, accessible to wheelchair users. Garden seating is available to residents wishing to sit outside and new patio tables, chairs and umbrellas are also available during the warmer weather. A rail is in place around the raised patio area outside the dining room to improve resident safety. Residents spoken with confirmed that their bedrooms suited their needs. Bedrooms are comfortably furnished and personalised to varying degrees. Primrose Lodge is registered to accommodate up to 27 residents in 4 double and 19 single bedrooms. However, the home has a policy, which states that only those who wish to share will be accommodated in a double room. At present, 3 of the 4 double rooms are used for single occupancy. A programme of refurbishment is in progress and so far, thirteen bedrooms have been redecorated and provided with new carpets, curtains, bed, bedding and high-quality furniture. All rooms are centrally heated and have natural light and opening windows. Secondary lighting is also provided. Residents commented, “I like my room very much. Everything is new and I think it looks lovely.” My room is very comfortable and I have a lovely view over the garden. “I spend a lot of time in my room and I think I have everything I need. I am very pleased with the new furniture and bed.” The laundry is equipped with two washing machines and two tumble dryers. At the time of the inspection, the home was experiencing difficulties with the washing machines and an engineer was on site to rectify the problems. Some laundry items were being taken to the local laundrette as a temporary measure. DS0000063469.V305352.R01.S.doc Version 5.2 Page 22 An infection control policy is in place. Mrs Mitchell said nearly all staff had now completed training in infection control and the staff on duty confirmed this. Suitable procedures are in place for the disposal of clinical waste. Residents commented, “This home is kept very clean.” This is a beautiful home. It has a lovely feeling to it.” “The home is kept clean and fresh.” However, one area of the home has an unpleasant odour. Mrs Mitchell is very aware of this recent problem and is taking the appropriate action to rectify the situation. DS0000063469.V305352.R01.S.doc Version 5.2 Page 23 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Primrose Lodge. The home employs sufficient staff to meet the current needs of residents and to ensure their safety and comfort. The home is working towards the recommended ratio of 50 NVQ level 2 trained staff, to help ensure residents are in safe hands. Robust employment and recruiting procedures are in place to ensure the protection of residents. Staff are provided with suitable training, so they will have the skills necessary to meet the assessed needs of residents. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the current needs of residents. At the time 8 a.m. to 8 8 a.m. to 2 2 p.m. to 8 8 p.m. to 8 of inspection, the following care staff were on duty: p.m. - 2 care staff plus 1 new member of staff “shadowing.” p.m. - 1 care staff. p.m. - 1 care staff. a.m. - 2 care staff (wakeful).
DS0000063469.V305352.R01.S.doc Version 5.2 Page 24 The home currently employs a total of 16 staff, including a chef, cook, and maintenance person. A new domestic assistant is due to commence employment shortly. Until this date, an Agency is supplying staff to carry out cleaning tasks. Discussion with residents and staff during the inspection showed that generally, staffing levels were now felt to be satisfactory although they had been a little stretched occasionally during busy periods of the day. Primrose Lodge has a dedicated team of care and support staff that are working positively with residents to ensure their needs can be met. Relationships between staff and residents were directly and indirectly observed throughout the course of the inspection. Staff were observed to be responding to needs appropriately and undertaking good care practice, demonstrating a caring, gentle approach when dealing with residents. Residents commented, Everyone here is brilliant, they have looked after me very well.” The staff are very kind. I have not wanted for anything. Some staff are better than others. Some are really good and would do anything for you. In the main, the staff are excellent. Nothing is too much trouble.” At the last inspection it was recommended that a minimum ratio of 50 per cent trained members of care staff at NVQ level 2, or equivalent, be achieved. Two members of staff have now attained NVQ level 2 and two staff are currently studying for a NVQ level 2. A further two members of staff have achieved NVQ level 3 and two more have commenced NVQ level 3 training. Mrs Mitchell is now working to achieve the target of at least 50 trained members of care staff at NVQ level 2 as soon as possible, to ensure residents at Primrose Lodge are in safe hands. The two staff files examined demonstrate that the home is operating a thorough recruitment procedure, to ensure the protection of residents. All necessary documentation is in place, including: • • • • • • • • • Interview assessment form Application form with employment history Two written references Enhanced Criminal Records Bureau disclosure Protection Of Vulnerable Adults check ID documentation Job description. Contract of employment Record of training, copies of training certificates An equal opportunities policy underpins the employment practice of the home.
DS0000063469.V305352.R01.S.doc Version 5.2 Page 25 The home takes staff training seriously as a means of improving the standard of care provided and ensuring residents safety. All new staff receive induction training and this is now based on the Skills for Care Common Induction Standards. Since the last inspection, an audit of staff training has been carried out and a document produced which clearly identifies the training achieved by all staff in the home and where further input is needed. All staff have received training in moving and handling, fire safety, Protection of Vulnerable Adults and health and safety. Those staff dealing with medicines have received training in the administration of medication. Most staff have now completed infection control training and training in first aid is being arranged. It is recommended that all staff that cook or prepare food in the kitchen, e.g., for the evening meal, should have basic food hygiene training. Staff commented, We do a lot of training here, which is really helpful. “Primrose Lodge is a good place to work. I have learned a lot since coming here.” “I did not think I would enjoy the training, but some of it has been really interesting.” Copies of all training certificates are being retained to provide evidence that staff receive a minimum of three paid days training per year. DS0000063469.V305352.R01.S.doc Version 5.2 Page 26 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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Primrose Lodge. Mrs Mitchell demonstrates a good knowledge of the operation of the care home and the needs of its residents. The home regularly reviews its performance and actively seeks the views of residents, staff and relatives to ensure the home is run in the best interests of residents. Residents are assured of sound management of their financial interests. Staff are being supervised at the recommended intervals, to ensure good practice. The home works to ensure the general health, safety and welfare of residents. DS0000063469.V305352.R01.S.doc Version 5.2 Page 27 EVIDENCE: Mrs Mitchell is the registered manager at Primrose Lodge, having worked previously as assistant manager. She has experience in caring for older persons and is currently working towards her National Vocational Qualification (NVQ) level 4 in care and management. It is a condition of registration that Mrs Mitchell must obtain an NVQ level 4 in management and care by August 2007 and this Standard cannot be fully met until this has been achieved. Mrs Mitchell says she is currently on course to meet this condition prior to August 2007. Primrose Lodge provides a supportive, caring and relaxed environment where residents say they feel comfortable and secure. Mrs Mitchell describes herself as a very “hands-on” manager and feels it is important to remain open and accessible to residents, visitors and staff. This was demonstrated throughout the inspection. Mrs Mitchell clearly has a good relationship with residents and staff. She says she always feels well supported by the registered provider, Primula Care Ltd. Residents spoke highly of the manager: “The manager is lovely, very kind. You can tell her anything.” “The manager is sweet. I enjoy talking with her.” “She is someone who listens to what you are saying.” “Debbie gets things done. If you tell her anything, she sees to it straight away.” Staff commented: “Debbie is very supportive. You can talk to her and she understands where you are coming from.” “She is very good, very fair.” Quality Assurance questionnaires have been sent out to residents, staff, relatives and other visitors to the home to obtain their views. Feedback from these is available in the Information File in the entrance hall. Regular audits also take place within the home and policies and procedures are regularly reviewed to ensure best practice. In order to protect residents, the home prefers to have no involvement in personal finances. Therefore, all residents who are unable or have no wish to handle their own affairs have a relative or other representative to deal with their finances. At present, the home pays for services such as chiropody and hairdressing and keeps a record of what is owed. This amount is then invoiced to relatives or representatives for payment. Information about advocacy services is available to residents and their relatives in the Information File within the home, should they need independent advice or support. DS0000063469.V305352.R01.S.doc Version 5.2 Page 28 Examination of supervision records shows that care staff are now receiving formal supervision at least six times a year, as a means of ensuring good practice, emphasising the philosophy of care within the home and looking at individual career development needs etc. Staff meetings also provide opportunities for staff to express their views and ideas. Staff appraisals are carried out annually to ensure they are fulfilling their role satisfactorily and meeting the needs of residents. From touring the premises, looking at records and discussions with staff and residents, it is evident that measures are in place to promote the health and safety of residents, e.g. equipment, such as the lift, alarm call system, hoists etc are regularly serviced and maintained. All substances that could be potentially hazardous to health are handled and stored safely and restrictors are fitted to windows. Work is now commencing on fitting guards to radiators and pipework to protect residents from potentially hot surfaces and ensure their safety. A Risk Assessment file is maintained and regular reviews take place each month, to ensure the safety of the building, equipment etc. Safety data and product information is held for all of the materials in use in the home. Examination of the fire records shows that appropriate procedures are in place to ensure the safety of residents and staff. Regular maintenance of the fire warning system, emergency lighting and fire fighting equipment is taking place. Routine checks are carried out at appropriate intervals and staff confirm this. Staff fire training and fire drills are also taking place so that staff are fully aware of the action to take in the event of a fire. DS0000063469.V305352.R01.S.doc Version 5.2 Page 29 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 DS0000063469.V305352.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 14 and 15 Requirement All aspects of each resident s health, personal and social care needs must be recorded and regularly reviewed. Care plans are to be agreed and signed by the resident or their representative wherever possible. It is required that the registered manager obtains a National Vocational Qualification level 4 in management and care. Timescale for action 31/10/06 2 OP31 9(2)(b)(i) 31/08/07 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 OP28 OP38 Good Practice Recommendations It is recommended that a minimum of 50 of care staff achieve NVQ level 2 training. It is recommended that radiators and pipework are guarded, or have guaranteed low temperature surfaces, to ensure resident safety. DS0000063469.V305352.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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