Inspection on 28/01/09 for Primrose Lodge [Bournemouth]

This inspection was carried out on 28th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Primrose Lodge [Bournemouth] 11/01/08

Primrose Lodge [Bournemouth] 01/09/06

Primrose Lodge [Bournemouth] 09/11/05

Primrose Lodge [Bournemouth] 04/08/05

Primrose Lodge [Bournemouth] 25/01/05

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Fairfields Country Rest Home

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Queensmount

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Belma

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Primrose Lodge [Bournemouth] 42 St Catherines Road Southbourne Bournemouth Dorset BH6 4AD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tracey Cockburn     Date: 2 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Primrose Lodge [Bournemouth] 42 St Catherines Road Southbourne Bournemouth Dorset BH6 4AD 01202429514 01202429514 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Primula Care Limited care home 27 Number of places (if applicable): Under 65 Over 65 27 old age, not falling within any other category Additional conditions: 0 One named person (as known to CSCI) under the age of 65 may be accommodated to receive care. Within the total of 27 places, two service users may be accommodated within Primrose Lodge over the age of 50. Date of last inspection Brief description of the care home 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. 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 and nineteen single rooms. All bedrooms, with the exception of one, have en-suite facilities. The lounge and separate dining room are Care Homes for Older People Page 4 of 27 Brief description of the care home situated on the ground floor. The home has an attractive front garden and a rear garden that is laid mainly to lawn with mature trees and shrubs and a paved patio area. Twenty-four hour care is provided. Laundering of personal clothing is carried out on the premises. All meals are prepared and cooked within the home. A choice of menu is offered. Activities are available to provide some stimulation and interest for people. The fees for the home, as confirmed to the Commission for Social Care Inspection (CSCI) at the time of inspection, range from 440 pounds - 575pounds per week. Additional charges include hairdressing, chiropody, dry cleaning, toiletries and newspapers. The Office of Fair Trading has published a report highlighting important issues for many older people when choosing a care home, e.g., contracts and information about fees and services. Further information can be obtained from the following website: - www.oft.org.uk Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We started this key inspection without any warning. We spent seven hours on a site visit to the home where we talked to the manager, people who live in the home and people who work in the home. We also observed staff at work. We looked at the annual quality assurance assessment sent to us by the manager as part of our planning of the inspection. We reviewed information the home had sent to us about incidents and accidents in the home. We looked at records the home keeps on how they support people, we looked at information the home keeps on how they recruit people to work in the home and we looked at information about how the home ensures people who live and work there are safe. Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 27 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using this service have their needs assessed before they make a decision and the manager confirms in writing that they are able to meet their individual needs. However the assessment should contain more detailed information so that a person centred approach can be taken to meeting care needs. Evidence: We looked at four files for people who live in the home. The pre admission assessment is not as detailed as it should be to provide the home with all the information it needs to make an informed decision. Some of the headings have insufficient information and only one word comments. Under the title expressing sexuality in all four of the files reviewed there was only one statement expresses self through clothes chosen to wear this did not fully explore equality and diversity. The manager said that she felt the assessment did not provide enough space to write more detail. However the people who live in the home said they were involved in the assessment process and Care Homes for Older People Page 11 of 27 Evidence: knew they had a care plan. There was also information in some cases provided from the funding authority. Care plans were based on information in the assessment. the manager has produced a easy read document which details information someone who moves into the home would like such as what time meals are, activities in the home, what papers can be delivered. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The annual quality assurance assessment says: All care plans are well detailed to enable staff to meet the needs of the resident. Any change in their needs is documented immediately and staff review the care plans monthly.The staff write good detailed information in the daily records of all residents.Where possible the residents are consulted in compiling the initial care plan and if this is not possible a resident or friend will be asked. Our recent quality assurance survey shows that the care given is very good. We looked at four files for people who use the service. In one file we found that a variety of assessments are completed including the malnutrition universal screening tool(MUST). However although the files said it had been used and the score was recorded the assessment tool was not in the file. We looked at one file which contained good information on the specific conditions Care Homes for Older People Page 13 of 27 Evidence: which affected the individual and what action staff should take to support them. One person had a skin assessment, risk assessments were in place regarding wandering and smoking. There was evidence that the person had seen the optician and the specialist nurse. Local authority care plan in place. The individual was visited by the chiropodist. One person was admitted with a low weight, this was monitored and recorded and the care plan was very specific and clear about the support needed for the person. One person self medicates and an assessment was in place for this including a risk assessment. Care plan contains information on nutrition and weight. For one person there was a manual handling assessment in place, a skin assessment had been completed, they were weighed on admission recorded. The care plans were dated and reviewed monthly with comments about changes and improvements. We spoke to people who live in the home and they told us that they feel well cared for and that staff always know what to do and have time to speak to them. One person said that they had been made to feel very welcome. They also told us that staff know when they want to be on their own and when they want support. One person was visited by the memory clinic, note which says pleased with progress. Evidence of visits by district nurses when necessary. We looked at the medication system in the home. They use a monitored dosage system and the medication cabinet is kept in a locked cabinet on the first floor. The home has a controlled drugs cabinet fixed to a solid wall in the same locked cupboard. Following advice from the pharmacist all liquids and creams are kept on separate shelves in the cupboard. an audit was completed on 25/09/08 by the PCT pharmacist. The manager told us that they are part of a community and nutrition support trail being run by Southampton school of medicine. This means that people in the home have nutritional assessments and advice from qualified staff. In one persons room the clock was not working, a member of staff told us the battery needed replacing. The clock showing the wrong time could cause confusion for the person who uses the room, this showed a lack of respect for the individual. Two members of staff were observed assisting one person from their wheelchair to an armchair in the lounge, they were using an aid. Both members of staff were talking to the person about the task they were performing and reassuring them. The manager told us that when the red arrows were flying over in the summer one resident was very upset by the noise it would cause. They bought earplugs for the individual so they were not distressed by the noise. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to participate in activities which interest them and are able to see the people they want to. Further work is needed to have a more person centred approach to finding out about peoples lives and interests. Evidence: The annual quality assurance assessment says: We have a good variety of activities and have outside entertainers in regularly. We complete social history books on each resident which gives us a lot more information to enable us to centre the activities around things they enjoy. We provide a good balanced diet and the residents have a good choice of menu. We welcome all family and friends who are more than welcome to stay and have a meal in the home. Each person has a document in their file called memories of me in most cases the document is completed well. However it was noted that in all of them assumptions are made about an individual and their lifestyle. Issues of equality and diversity were not addressed or even suggested in the questions staff are encouraged to ask. We discussed this with the manager and she could see that the questions needed to be changed to reflect the individual more. The manager told us that they will be purchasing an electronic game for people in the Care Homes for Older People Page 15 of 27 Evidence: home to use which will keep them fit and encourage participation. People told us that the food is quite good One person told us the meat at lunch on the day of the site visit was very tough they also told us that this is the first time the meat has ever been tough. One person ate their lunch in the lounge, the member of staff asked them if they wanted to come into the dining room for lunch and when they said no they were asked if there was somewhere else they wanted to eat their meal and they indicated that they wanted to remain in the lounge. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to an effective complaints procedure and are protected from abuse. Evidence: The annual quality assurance assessment says: Quality assurance audit, all staff have received adult protection,abuse training, we have a good complaints procedure and adult protection policy. All residents have a copy of the homes complaints procedure in there Service user guide in there bedrooms and all of the residents/families know who to contact if they had a complaint. Only one complaint since the last inspection. We noted that the complainant had been responded to within the timescale specified in the homes complaints procedure. All staff have received safeguarding training and the requirement from the last inspection has been met. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment which is warm and comfortable, however there are not enough assisted baths so that people can take a bath when they want to. Evidence: The annual quality assurance assessment says: Rooms have been carpeted, new curtains and new furniture. Flat screen televisions have been purchased for the residents rooms and we have a new flat screen TV in the lounge. Infection control policy is in place and staff have received training on this. There are a number of environmental changes taking place in the home, walls are being painted and decorated, the hall is being updated and one bathroom has been refurbished into just a toilet. Some of the windows have been replaced with double glazed ones. There are a number of rooms on the second floor five in total which have not been replaced yet but must be restricted. The manager said that all the windows were going to be replaced. The skylight on the top floor is cracked. Although all the rooms on the top floor have en-suite bathrooms the manager said that the baths are not used and the showers have been capped off. There is only one usable bathroom for people living in the home to have a bath, this is on the ground floor. Therefore people in the home cannot have a bath when they want to. The manager acknowledges this is a problem and has been raised with the provider. At the Care Homes for Older People Page 18 of 27 Evidence: time of the visit there were eighteen people living in the home. There are a number of other bathrooms and toilet around the home. The bathroom which is always used for bathing is the only one which has an accessible bath seat for people to use. The kitchen is large and modern. The lounge is comfortable and homely with a variety of different seating for people to choose. The lift is very small and both staff and people living in the home find it difficult to use. The manager said that they have to use a small wheelchair as a normal sized one does not fit in the lift. The home does not smell and the odour in one room which was identified at the last inspection has been addressed. All bedrooms are personalised and the home is warm. Most of the radiators are covered. The laundry room is a small area by the back door. There are two washing machines and two tumble dryers. There is not a great deal of space for staff to work. However the area is easy to clean and there is a small handbasin for staff to use. The garden is large and mostly lawn and trees. There is a patio area for people to use. The home has a maintenance person. The ceiling in the dining room is stained. The manager told us that the maintenance person replaces the tiles when they become stained but it is hard to find a match. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. It is important that staff receive training in all aspects of care which inform their work and support people living in the home. Evidence: The annual quality assurance assessment says: We have a full staff team on all shifts and brilliant team work, low turn round of staff, excellent recruitment procedure, good staff training. Good staff training with all staff either on or completed NVQ level 2 and 3. We looked at three staff files. For one person there was a job application which was completed and dated. The Criminal Records Bureau check and the Protection of Vulnerable Adults (POVA) 1st were returned before the person started working in the home. In one staff file we looked at there was a to whom it may concern reference. The manager had sought a third reference. At the time of the site visit we found three carers on duty, one of whom is a senior, one domestic, one cook and one maintenance person. The manager works a forty hour week. Manual handling training, Health and safety training as well as Abuse, infection control Care Homes for Older People Page 20 of 27 Evidence: and fire training all completed with one month of starting work. Proof of identity on all three files. Six staff have started their National Vocational Qualification (NVQ) at level three. Three staff have NVQ at level three. One person has started NVQ at level 2 and two staff have NVQ at level two. There are sixteen staff in total working in the home. Nine staff have not completed any training in Dementia care. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is undertake by an experienced person who understands the needs of the people using the service. To ensure the effectiveness of the quality assurance process people need to know the outcome of surveys they participate in. To ensure the health,safety and welfare of people using the service action has to be taken to minimise any risks. Evidence: The annual quality assurance assessment says: We continue to look for ways to improve where possible and the change in new management company will enable us to move forward. The home is well managed and the residents feel safe and secure within the home. future development Looking at introducing more meaningful activities, refurbishment of rooms, more staff have received nvq training. Care Homes for Older People Page 22 of 27 Evidence: We found the manager was very open about the shortcomings in the service mainly around the environment. The manager was also clear that changes to the decor and condition of the home was being addressed by the registered provider. The manager has been in post a number of years and is very experienced and has undertaken management training. The home has a QA process and at the end of last year produced a document which collated all the information gathered in surveys sent to people who live in the home as well as people who have an interest in the home. There has not been any feedback to people who completed surveys. The manager told us that the views of people using the service are sought twice a year. A suggestion box has been placed in the hall for people to put their comments and suggestions into. We found out from the manager that the boiler is being serviced and replaced at the beginning of February. The fire officer visited on 10/06/08 and found the fire escape to be unsafe, the fire escape has been welded and is now secure. The last fire drill took place on 6/01/09. Weekly fire maintenance checks were completed on 20/01/09. The manager undertakes a monthly accident audit the last one completed on 31/12/08 and all incidents are analysed. We found that some of the windows on the second floor are not restricted which could pose a risk to the people who live in the home. Where windows have been replaced we found these to be restricted. It is important that action is taken to restrict those windows and risk assess each person in a room which has a window unrestricted until action is taken. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 21 23 The registered provider must have regard for the number and needs of the service users and provide at appropriate places in the premises sufficient numbers of baths and showers fitted with a hot and cold water supply. People living in the home should be able to bathe when they want to and with only one assisted bath this is not possible. 30/04/2009 2 38 13 The registered provider 30/04/2009 must ensure that all parts of the home are so far as reasonably practicable free from hazards to their safety. Windows which are unrestricted pose a hazard to peoples safety. The health and safety of people living in the home is important and as such windows must be restricted. Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 The registered manager should ensure that the pre admission assessment contains more detailed information about the individual so all their needs and wishes can be fully met. Using standard phrases in the comment box does not clearly express an individual or their needs. The registered manager should consider how people are talked to about their lives and interests and more effort should be made to approach this in a person centred way. The registered manager should ensure that staff have training in skills areas such as dementia care to help inform their practice and understand the people they are supporting who live in the home. The registered manager should produce a report based on the information sought in the questionnaires. This report should be available for people who are interested in the service. 2 12 3 30 4 33 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!