CARE HOMES FOR OLDER PEOPLE
Radway Lodge Vicarage Road Sidmouth Devon EX10 8TS Lead Inspector
Teresa Anderson Key Unannounced Inspection 17th August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Radway Lodge DS0000022011.V300830.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. Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Radway Lodge Address Vicarage Road Sidmouth Devon EX10 8TS 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) 01395 514015 The Radway Partnership Mrs Sheila Mary Tallon Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: Radway Lodge is a detached house situated in a central position in the town of Sidmouth. The home provides accommodation with personal care for up to 15 older people. Bedroom accommodation for residents is on the ground and first floors and all the bedrooms are singles. There is a stair lift to the first floor. There are some steps throughout the home that makes access difficult for service users who are wheelchair dependant or who have mobility problems. There is a communal lounge and a separate dining room on the ground floor. There are pleasant gardens and an outside seating area. There is a small car park to the rear of the home. Information about this home, including reports, is available direct from the home. The fees charged range from £375.00 to £500.00 per week. Additional charges are made for items such as toiletries and newspapers. The home tries to provide transport for hospital appointments at no extra cost, where possible. Where families cannot accompany residents to hospital appointments, the home provides an escort at no extra charge. Radway Lodge DS0000022011.V300830.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 one day as part of the normal programme of inspection. Before the visit to the home the manager and owner completed a pre-inspection questionnaire providing information about the home. Questionnaires were sent to 7 residents and 6 were returned, to 4 health and social care staff and 4 were returned, to 9 staff and 6 were returned. During the visit to the home the inspector concentrated on looking at the care and services offered to three residents who have different needs. She also spoke with many of the 15 residents, with relatives, staff and with the owner and manager. She saw many of the resident’s bedrooms and the majority of the communal areas. What the service does well:
Before being admitted to the home each prospective resident is assessed by the manager to ensure that the home and staff can meet the needs of that person. At this time, they or their supporter is given information about the home. Each resident has a plan of care which is well understood by staff and which takes account of the individuality of each resident. Residents’ healthcare needs are well met through the involvement of healthcare professionals and residents say that staff always listen and act upon what they say. One resident has been referred to the local physiotherapy department and is showing clear signs of improvement. One resident has been provided with an electric chair to help her remain independent. Systems for managing medications are good. Staff receive training from the local Primary Care Trust and their competency is checked by the manager. Records are up to date and in order. On the whole the privacy and dignity of residents is respected and staff pay regard to the age and status of the residents. Radway Lodge is situated at the heart of a close knit community and as such residents have access to all the local amenities. Residents are encouraged to continue with their leisure pursuits and visitors are encouraged and welcomed. Food is cooked on the premises and is described by residents as ‘good’ and ‘lovely’. There is plenty of choice with hot and cold drinks available on request. Residents say they know how to make a complaint but do not need to. Staff are trained in the Protection of Vulnerable Adults and residents say they feel safe and well cared for. The home is clean, fresh and safe throughout. Staffing levels are adequate to meet residents’ needs. Staff receive appropriate training and about 33 are trained to NVQ Level 2 or above. Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 6 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. Radway Lodge DS0000022011.V300830.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 Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The information available to prospective residents about the home helps prospective residents to make an informed decision about where they live. This may not always be given to prospective residents and/or their supporters. Assessments of residents prior to admission ensure that staff can meet their needs. EVIDENCE: Radway Lodge has produced a guide to the home that sets out the services offered by the home, its limitations and the type of home it is. Although two of the six questionnaires returned to the Commission by residents said they did not receive enough information, the manager believes this may be because they had forgotten receiving this. One respondent said that the manager and owner were very informative and another said that there was ‘casual information only’. Before being admitted to Radway Lodge the manager meets with the prospective resident, undertakes an assessment and collects information about
Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 9 the resident from sources such as health and social care staff. People are encouraged to visit the home and meet with the staff and residents prior to admission. By doing this the manager hopes to ensure that the home and staff can meet the needs of each resident and the resident can make an informed choice. All residents spoken with or who returned surveys said they are happy with the choice they have made. Radway Lodge DS0000022011.V300830.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The arrangements in place for planning and providing residents’ care ensure that residents get the care they need in a way that suits them. The health care needs of residents are met with evidence of multi-disciplinary involvement. The systems for the administration of medication are good and ensure service users medication needs are met safely. Personal support is offered in a way that promotes and protects residents’ privacy and dignity. EVIDENCE: Each resident admitted to Radway Lodge has a plan of care that identifies their needs and sets out directions for staff on how these needs should be met. Speaking with residents and staff indicates that resident’s preferences and their individuality are taken into account in the delivery of care. Residents say they receive the care and support they need and that staff always listen and act upon what they say. One resident said that staff show good attention to ‘small things’ and make sure that she has everything that
Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 11 she needs to hand. Two visitors said they were completely happy with the care. Returned surveys from health and social care staff also indicated their satisfaction with the care provided. Three plans were inspected. They all contain information that is important for staff to help them meet heath, welfare and social needs. Each contains evidence of staff involving and working with health care professionals such as doctors, chiropodists, dentists, and specialists. One resident referred to the local physiotherapy department is showing clear evidence of improvement. One resident has been provided with an electric chair to help her remain independent. Although residents are assessed for their risk of falling these do not contain enough information for staff about what actions they need to be take to help minimise the risk of falling. Systems for managing medications are good. Records are up to date, staff receive training and updates from the local Primary Care Trust and the manager carries out audits and competency checks. Information about the medication prescribed to residents is available. Medications are stored safely and in accordance with good practice guidelines. Residents say that staff treat them with respect, for example speaking respectfully to them, paying regard to their age and addressing them in the way they prefer. Although staff were observed knocking on bedroom doors, one resident says this does not always happen. Whilst this resident says they do not mind this, this is not good practice. Radway Lodge DS0000022011.V300830.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Links with the community and visitors are good and, in general, residents have their social care needs met. Support is offered in a way that promotes choice and flexibility. The meals offered provide choice, variety and meet nutritional needs. EVIDENCE: Radway Lodge is situated in the heart of Sidmouth. Residents who live here are relatively able and as such are encouraged and supported to maintain their links with the local community. Visitors come and go, residents go out into town (some independently, some with help) and some residents continue membership of local clubs. The home does not have a programme of social events, although a weekly bingo session is held, and some residents say this suits. A ‘music man’ visits and some trips are arranged to local attractions. In the winter staff and residents report that more in-house activities such as skittles and quizzes take place. However, four of the six residents who responded in surveys said they were only ‘usually’ or ‘sometimes’ happy with the activities arranged by the home.
Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 13 Staff demonstrate a good understanding of the importance of ensuring that residents continue to have choice and make decisions about their daily lives. They talked of letting ‘residents do their own thing’. Residents say they go to bed when they like, get up when they like and eat where they like. One resident who has limited sight described how she tells staff what she would like to wear and how they oblige. Residents describe the food at Radway Lodge as ‘lovely’ and ‘good’. Five of the six respondents to surveys said they always like the meals. There is a fourweek and seasonal menu and all food is cooked on the premises. Breakfast is served in residents’ bedrooms; lunch tends to be taken in the dining room and supper in bedrooms or the dining room. Supper is served at 5.30pm. Whilst the inspector was concerned that residents might get hungry before bedtime, residents said they did not and that they could ask for something if they wanted it. Radway Lodge DS0000022011.V300830.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints system. Residents feel safe and well cared for and staff’s knowledge of adult protection ensures that residents live in an environment where they are protected from abuse. EVIDENCE: The home has a complaints procedure. Residents say that they are always listened to and do not have to make complaints. Respondents to surveys say that they know who to speak to if needed. The manager reports that training in the Protection of Vulnerable Adults has been updated since the last inspection and that all staff have received this. Residents say they feel safe and well cared for. One resident, without prompting, said she could trust the staff. The Commission has not received any complaints about this home. Radway Lodge DS0000022011.V300830.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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The environment of this home provides residents with a homely, clean and safe place to live. EVIDENCE: Residents say that the home is always or usually fresh and clean. All areas seen by the inspector were clean and tidy. Corridors are kept clear so that residents can walk around safely and fire precautions are followed. Some decoration has taken place including the hall, stairs and landing and some bedrooms. The home does not have a sluice and for this reason the manager was asked to ensure that the procedure for dealing with materials that need sluicing addresses this. Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area is good. This judgement has been made using available evidence including a site visit. Staff have the qualities and skills and receive appropriate and sufficient training to provide residents with the support and care they need. Recruitment procedures designed to protect residents are good and are being followed consistently. EVIDENCE: Residents say that staff are ‘lovely’, ‘kind’ and ‘thoughtful’. They say that there are enough staff on duty to meet their needs although they are kept busy. Staff say they are never asked to care for residents outside their area of expertise, generally know what to do if someone is unwell or if their needs change and get the support they need from the management system. The manager reports that staff training is given (records to follow) and that approximately 33 of care staff are trained to NVQ Level 2 or above. Three recruitment files were checked and all contained information necessary about the carer to ensure the protection of residents. Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 17 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a site visit. The manager is well supported by the team and together they have devised management and communication systems that ensure residents live in a wellmanaged and safe environment where they are protected. EVIDENCE: The Registered manager is trained to NVQ Level 3 and has many years experience in the caring profession. Staff and residents talked of their confidence in the manager and their respect for her. Healthcare professionals commented that this is a well managed home. The owner holds the Registered Managers Award and, as part of her role, is responsible for deciding upon and implementing a cycle of quality assurance. Residents spoken with could not think of anything that might improve the
Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 18 home and are happy with their level of involvement. Returned surveys from health and social care staff indicated that this is a well managed home. Monies are kept safely and securely and the system is auditable. Access to these monies is restricted. Three accounts were checked and found to be in order. The manager reports that staff receive mandatory training to promote safe working practices. This includes infection control, first aid and fire training. The owner and manager completed a preinspection questionnaire indicated that all the required checks and maintenance contracts are in place. Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 19 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 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP8 OP10 OP12 OP26 OP28 OP31 Good Practice Recommendations You should ensure that appropriate actions are taken to minimise the risk of residents falling. You should ensure that residents’ rights to privacy is upheld by for example staff knocking on bedroom and bathroom doors before entering. You should make sure that all residents have opportunities to exercise their choice in relation to the social activities offered by the home. You should ensure that the policy relating to sluicing takes into account that the home does not have a sluicing facility. You should continue working towards training 50 of care staff to NVQ Level 2 or above. The registered person should hold the Registered Managers Award or be studying for it. Radway Lodge DS0000022011.V300830.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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