Inspection on 30/05/07 for Robert Bean Lodge

This inspection was carried out on 30th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Robert Bean Lodge 08/05/08

Robert Bean Lodge 30/08/06

Robert Bean Lodge 22/02/06

Robert Bean Lodge 06/09/05

Robert Bean Lodge 06/09/04

Robert Bean Lodge 28/07/04

Robert Bean Lodge 04/03/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Robert Bean Lodge Pattens Lane Rochester Kent ME1 2QT Lead Inspector Sue McGrath Key Unannounced Inspection 30th May 2007 9:30 X10029.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 Robert Bean Lodge DS0000036756.V341653.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 and Care Homes for Adults 18 – 65*. 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. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Robert Bean Lodge Address Pattens Lane Rochester Kent ME1 2QT 01634 831122 01634 831113 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) Medway Council Mrs Vivianne May Simmons Care Home 44 Category(ies) of Learning disability (4), Old age, not falling registration, with number within any other category (40) of places Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 4 beds registered for Learning Disability are for Respite use only. Date of last inspection 19th January 2007 Brief Description of the Service: Robert Bean Lodge is a purpose built home which includes a community day centre. All of the accommodation is on the ground floor in single rooms. The accommodation is divided into four units, each containing ten bedrooms and separate day space. Medway council runs the establishment, which is registered for forty older people. The home is on a bus route and has off road parking available. The home employs care staff, working a roster, which gives 24-hour cover. The home also employs other staff for catering and domestic duties. In addition the home is temporarily accommodating a Younger Adults respite care service. This is registered for 4 persons and is self-contained with its own staff team. The elderly residential home charges are £388.50 per week, which is dependent on an individual financial assessment. The younger adults’ respite service financially assesses each service user. Charges are dependent on level of benefit being paid and range from £1.00 to £22.00 per night. The service is subsidised by Medway Council. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on Thursday 31st June 2007 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the Residential Unit site visit, service users and staff were spoken with, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. A second site visit was undertaken on Friday 1st June for the Younger Adults Respite Unit. Some clients and staff were spoken with, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. Not all of the requirements made at the last inspection had been complied with. What the service does well: Elderly residents benefit from living in a home that is clean and recently decorated internally. The home is clean and free from offensive odours throughout. Generally residents benefit from staff that have the skills and training to meet their needs. During the inspection the vast majority of the residents confirmed that they were well looked after and that staff supported them well. Comments on the food were varied. Resident now benefit from having written contracts in place. Staff were seen to communicate effectively with the residents and were caring and supportive. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Seven of the last twelve requirements have not been met and are again repeated. The registered provider must produce an improvement plans giving details and timescale of when these requirement are to be met. Care plans are inadequate and do not give care staff sufficient information to ensure appropriate care is given. Risk assessment needs to be more individual and guidance must be given to staff to ensure risks are reduced. Safe systems of working should be introduced. The issue raised at the last inspection regarding service users monies has not been addressed. This was also carried over from the previous report and must be addressed. Although plans are in place to recruit more care staff, the current high level of vacant hours means there is high agency usage. The younger persons respite unit was originally agreed as a temporary measure, however that was two and a half years ago. Little evidence could be found that concrete plans were in place to find a more appropriate setting. This is an important service, which is highly valued by its customers who could be reluctant to complain. The registered provider must make every effort to find a suitable environment in the immediate future. The outside of the building is in need of urgent maintenance, as pathway which have been identified as fire exits are covered in moss and in some place obstructed by over4growing trees and bushes. Garden debris and old chairs also obstruct some fire doors. The gardens are overgrown, preventing proper use and with the summer nearly here, residents will be unable to enjoy any sunshine and fresh air. Some overgrown trees are obstructing some bedroom windows making then dark and gloomy. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 7 Residents complain of being bored and having little to do. The home must provide suitable activities to ensure residents lifestyles match their expectations, cultural and recreational interests and needs. The registered provider must ensure a registered manager in is post to manage the home effectively. The situation with the new bathroom not being used needs to be resolved. 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. The summary of this inspection report can be made available in other formats on request. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Older Persons Residential Home. Older people do not always benefit from having their needs assessed prior to moving into the Home. Residents are now provided with a statement of terms and condition of residency. Younger Adults Respite Unit Younger persons prospective service users know that their individual aspirations and needs will be assessed. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 10 EVIDENCE: Older Persons Residential Home. The home’s does have a Statement of Purpose and Service User Guide but both documents require updating to reflect what is actually on offer at Robert Bean Lodge. This was discussed with the Acting Manager who agreed to make the necessary changes. It was also advised that the guidance available on CSCI’s website regarding the ‘Provision of Fee information by Care Home’s’ is included in the updated Service User Guide. It was also a concern that the Statement of Purpose was not readily available for prospective residents and their families. The acting manager said that Service User Guides are placed in all of the bedrooms for residents to read at their leisure. The acting manager confirmed that all residents now have a written contract/statement of terms and conditions with the home. This was confirmed when some files were inspected. Some of the files viewed did not contain full assessments of need by the home although it was confirmed by the Acting Manager that if they have a concern over a prospective resident, senior managers will visit the prospective resident in their current setting to ensure their assessed needs are met. Some care manager’s assessments were seen. A full inspection of care plans and daily monitoring records shows a lack of information had undermined the quality and safety of their care. One respite resident had no care plan at all and very little assessment information. This resident showed signs of dementia so it would be unlikely that accurate information could be gathered from them. The home will be required to improve and evidence that thorough assessments are taking place prior to admission. Without adequate assessment it is difficult to assess if needs are being fully met by the home. The acting Manager confirms that all residents and their families or representatives are encouraged to visit the home prior to admission and to be involved fully in the admission process. Often residents have respite care prior to needing permanent care. Robert bean Lodge does not offer Intermediate care. Younger Adults Respite Unit When the Commission agreed to the unit moving to Robert Bean Lodge it was agreed that it would be a temporary measure for up to six months. The present situation has lasted for over two and a half years and Medway Council Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 11 are urgently requested to make arrangements for new premises to be made available. A sample of clients’ files was viewed and all contained appropriate comprehensive assessments and care plans. The manager explained that service users are assessed in their own homes if needed and a good relationship is promoted between the respite and day service, which most service users attend. As well as care manager assessments the service seeks information and feedback directly from parents and carers regarding the needs and wishes of prospective service users. Care plans are reviewed at each admission and if conditions or needs have changed, the plans are altered to meet the new need or a full care management review is arranged. Following discharge from the unit families are contacted, normally the following day, to ensure they remain happy with the service and that the client has settled back home. The manager and team are currently developing a pack to take to the client’s homes to improve on the information given to families. This will include the written agreements, care plans, risk assessments and the units Statement of Purpose and Service User Guide. Staff have been involved with drawing up these documents and are looking forward to improving the relationship with the clients families. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Older Persons Residential Home. Residents’ health, personal and social care needs are not adequately set out in their care plans. Residents are potentially at risk from poor medication administration practises. Residents know that they will be treated respectfully and their right to privacy will be upheld. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 13 Younger Adults Respite Unit. Clients health, personal and social care needs are adequately set out in their care plans and met. Clients know that they will be treated respectfully and their right to privacy will be upheld. EVIDENCE: Older Persons Residential Home. Care plans and monitoring records are not comprehensive enough to ensure that service users’ health, personal and social cares needs are being met. Assessment and care plans, including risk assessments, lacked detail and some sections were not filled in at all. Lack of assessment and poor monitoring could mean that not all care needs are being fully met. One respite client did not have a care plan at all, although this was not her first visit. All that was in her files was some basic daily notes. Some risk assessments identified risk but no safe system of working had been completed to ensure staff acted appropriately. Some moving and handling assessments were not completed sufficiently and again gave no safe system of working. Risk assessments generally were not specific and lacked detail. Several residents had a diagnosis of diabetes and no risk assessments or guidance to staff were included in their care plans. Residents who had a history of falls were also not adequately assessed. Some care plans appeared to have regular reviews but little evidence could be found that residents and or their representatives had been involved in the process. It will be a requirement that care plans are drawn up that meet the relevant clinical guidelines produced by the relevant professional bodies concerned with the care of older people and that the plans set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the resident are met. Health care needs were being mainly met and the home now recorded outcomes from GP and or DN visits. Residents spoken with confirmed they could see their G.P. if they needed to. Evidence was seen of regular chiropody clinics. Staff spoken with displayed a good understanding of tissue viability and the prevention of pressure sores. There is little evidence that nutritional screening is undertaken on admission and subsequently on a periodic basis (NMS 8.9) although evidence was seen Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 14 that some residents are weighed. The home does have a chair scale for residents to use safely. Staff confirmed that residents are taken for audiology testing if required. The home’s administration of medication was assessed during the inspection. One care plan stated that the resident self-administered medication but in reality this was not the case. The Acting Manager is advised to ensure care plans reflect actual practise. The home has its own dedicated medication room, which is kept locked. This could be improved with a thorough spring clean including the floor. In addition, medication cabinets and a medication fridge are in place with appropriate temperature controls. The home uses the Boots Monitored Dosage System. The ordering and storage of medication is satisfactory including the method used for returning unwanted drugs to the Pharmacist. The controlled drugs register is managed well. One major concern was the actual administration of the medications. One senior member of staff was observed not following the home’s guidance for administration. When questioned about the error, no adequate reason was given for the non-compliance. For this reason the inspector felt it is necessary to lower the scoring given for the safe admission to poor because of the concern that this might be the normal practise. It is strongly advised that staff who are responsible for administering medication are regularly assessed to ensure they are following the home’s policies and procedures for the safe administration of medication. The register manager must evidence that the system used is safe. Residents spoken with confirmed that staff treated them with respect and they felt well cared for. Comments made included ‘Staff are very helpful and look after me well’ ‘I feel safe in here’ ‘The staff are wonderful and help me a lot’ ‘They normally answer the bleep quickly if I ask for help’ ‘They respect my privacy especially at bath times’ Younger Adults Respite Unit. A sample of clients files show that care plans reflect their needs and are comprehensive and detailed and include risk assessments. These are reviewed regularly and detailed daily monitoring of care is recorded. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 15 Clients spoken to and observation during the site visit showed that staff respected service users’ right to make choices. Service users said that staff were nice and that they could go to bed when they liked. Clients were observed making choices regarding activities and having options presented to them in a respectful manner. Appropriate guidelines and safety checks were in place to take account of the medication routinely being received from and returned to service users’ homes. Medication was counted in and out and properly recorded. Guidelines were in place to ensure that only appropriately labelled medication was received into the unit and administered and staff training records showed that staff had received medication administration training. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Older Persons Residential Home Residents do not always find the lifestyle experienced in the home matches their expectations and preferences. Residents are supported to maintain contact with family and friends as they wish. Residents receive a wholesome, appealing and balanced diet in pleasing surroundings at times convenient to them. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 17 Younger Adults Respite Unit. Clients are denied some opportunities to develop their independence skills in that they are not able to take part in planning shopping and cooking their meals. Clients do not have the benefit of eating their meals in a congenial setting. EVIDENCE: Older Persons Residential Home. Virtually all of the residents spoken with complained of the lack of activities and outings. They mostly complained of being bored and found the days to be very long. The home used to have a dedicated member of staff for activities but due to sickness and other reason this post is not currently in use. The Acting Manager did say that a temporary position is currently being advertised. Residents say that some staff do try to arrange some activities such as bingo, but not on a regular basis due to pressure of work. One new resident stated that he had bought some puzzle books with him, but did not know what he would do when he had completed them. He was able to purchase a daily paper but was not aware of any other books or magazine being available for general use. Another respite client stated that she had never been asked what she would like to do. Residents said they would enjoy cards games, puzzles and other board games and that outings would be very much enjoyed. One resident said ‘I am fed up having to look at open mouths all day where people are so bored they fall asleep’. The home does have a weekly exercise class, although this only consists of armchair exercises. It was clear that some residents would benefit from more varied exercise options. Residents also confirmed that they had music once a week. Residents confirmed they could have visitors whenever they like and feedback from relatives comment cards indicate they felt able to visit at any reasonable time and without warning. They spoke highly of the staff team and thought that they communicated appropriately with them in the best interests of their relative. The inspector is confident the care staff work diligently to ensure a good level of care is provided. Some good examples of positive interaction was see between care staff and residents. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 18 There was a mixed response regarding the food some agreed it remained good, others had reservations. Two residents stated they had far too much mince cooked in various forms. All agreed choices were given, mainly jacket potatoes with salad or omelettes. The main meal seen on the day looked appetising and well cooked. Staff were seen asking residents about portion size and personal preferences. Fresh fruit was readily available in the units. Younger Adults Respite Unit. The inappropriate building that houses this respite service does not aid integration of the younger people into the local community and is not in line with younger adults’ preferences for small family scale home’s. Now that the Day Centre for older people is open seven days a week the respite clients have lost the use of the Day Centre space over the weekend. This means they only have the two small living rooms at their disposal. If four of the clients are in wheelchairs this means that they cannot access the dining room at the same times. The same dining room is also used as an office. It does not have running water or any cooking facilities. It is acknowledged that all clients attend weekday services during the day and undertake a range of activities there. The unit does sometimes have access to a bus at the weekend but its use is dependent of the availability of a driver and often the clients have to remain in the unit all day. There is also a problem if the clients do not want to go to their day centre or are unwell during the weekdays. Even if they are unwell they have to attend the day centres because of lack of space in the unit. The day centres do have facilities for anyone feeling ill, but this means the clients are denied choices about what they can do. Communication between clients, relatives and staff is given a high priority in this respite service. The inspector is impressed with the systems in place to ensure proper feedback to and from relatives regarding service users’ stays. It is also clear that the service is very flexible when relatives need to change dates or are having to manage emergencies. Although service users are happy with the quality of food provided it does not allow for service users’ involvement in the planning and cooking of meals. The elderly services main kitchen prepares all food and the menu is essentially planned around their needs, although special dietary needs of the respite service are catered for. The respite unit does not have its own kitchen or food preparation facilities and does not even have its own sink. The unit’s dining room is too small to accommodate four service users and staff to support them to eat at the same time. Service users have to use the lounge area, which is also small. The way that food is provided is institutional in style and totally inappropriate for this younger adults service. The unit does have a fridge, toaster and microwave and can store and prepare small snacks if needed. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 19 These same comments were made at the inspection dated 30/08/06 and no improvements have been made. Although a requirement for relocation was made at the last two inspections, Medway Council has taken no action and further action by the Commission may be taken. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Older Persons. Residents and their relatives can be confident that their complaints will be listened to and acted upon and that they will be protected from abuse. Younger Adults Clients and their relatives feel their views are listened to and acted upon and that they will be protected from abuse, neglect and self-harm. EVIDENCE: Older Persons Residential Unit. Records seen and discussion with residents and comments from relatives showed that complaints are listened to and acted upon. The home has an Adult Protection Policy and procedure in place, which includes whistle blowing. Discussion with staff and training records seen showed that some adult Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 21 protection training was undertaken. Some staff require updating on Adult protection training. Younger Adults Respite Unit. Records seen and discussion with service users and staff showed that complaints are listened to and acted upon. The unit has an Adult Protection Policy and procedure in place, which includes whistle Blowing and discussion with staff and an examination of training records showed that adult protection training was undertaken. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23 and 26 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Older Persons Residential Unit. Residents benefit from living in a safe comfortable well-maintained internal environment that is clean and free from offensive odours. However poor maintenance of the gardens and pathways prevent residents from accessing any outside facilities. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 23 Younger Adults Respite Unit. Clients do not live in a homely, spacious environment with the appropriate specialist facilities and equipment to meet their needs. EVIDENCE: Older Persons Residential Unit. Some work to the internal environment since the last inspection included redecoration of the lounges following advise from Kent Association for the Blind. Some new lights have also been fitted. The state of the gardens and exterior pathways is a cause for concern. There has clearly been no maintenance work done for some considerable time. This means that the grass areas are badly overgrown with some weeds reaching over four feet in height. Some litter on the grounds to the front of the building does not give a good impression of the home. The trees surrounding the home are in need of some attention, as they are overgrown and make some of the bedrooms very dark and dreary. Some residents had concerns over the safety of these trees. The pathways around the building, which are the nominated fire exits, are covered in a green moss, which would be slippery when wet. This is a major hazard should the home need to be evacuated at any time. The poor state of the gardens and garden furniture also means the residents cannot access them with being escorted by staff. The acting manager confirmed this. This effectively means that residents cannot come and go freely in the gardens. The courtyard also houses a garden shed, which is in a very poor state of repair with the edged of the glass windows being exposes where the wood is rotting. This needs to be removed to ensure the safety of anyone using the gardens. The acting manager is aware of the problems and has obtained some quotes for remedial work but the provider has not approved this work. The garden need to maintained throughout the summer so that residents can enjoy some fresh air, particularly if outside activities are not arranged. Although the home boasts new bathrooms one is not in use as it is not suitable for the client group and residents are afraid to use it. Every effort must be made to ensure the bathroom is functional. Residents on that unit have to use the bathroom on another unit if they do not like having a shower. Most of the bedrooms viewed were reasonably decorated but some could be improved. Most were well personalised and all were clean. The home generally was clean and tidy. Although all of the sluice rooms had digi-locks fitted, none were in use on the day of the inspection and some chemicals were seen on some work surfaces and on top if cupboards. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 24 Younger Adults Respite Unit. As mentioned earlier in the report the respite unit moved from Napier Road to Robert Bean Lodge over two and a half years ago. It was agreed at the time that this would be a temporary measure for six months. Although several requirements have been made for the provider to provide an action plan detailing when the service will be relocated no action has been taken. The current situation is not acceptable for the clients as the lack of proper facilities restricts the freedom of movement and independence. The dining area does not even have running water for residents to drink or wash their hands. Either bottled water is used or clients have to go to the toilets to wash their hands. The area just outside the dining room could also be considered a risk, as clients cannot see if any staff from the residential unit are pushing food or other trolleys. There is the potential for some clients to be injured if they collide with these trolleys. One member of staff has already walked into a trolley. The manager has installed a mirror but this is not suitable for all clients. One client in particular shuffles along the corridors and staff have identified he is at serious risk and have to escort him at all times. This is restricts his freedom and independence at all times. This client has remained at Robert Bean Lodged for the last eight months since the death of his main carer. This area should not be used as a permanent setting. This is a clear breach of regulation and further action is being considered. The manager also has concerns over the loss of clothing when it is washed as it sometimes gets muddled with the washing from the residential end. Staff work hard to try to maintain the area but it is not suitable for this client group. A new small patio area has been built which at least gives a little extra space in the summer months. The unit has four bedrooms, two with ceiling hoists and one mobile hoist. The unit shares a bathroom with the day centre but the Parker bath does not meet the needs of the respite clients who mainly all require specialist baths. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. 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 this service. Older Persons Residential Unit. From responses given by residents and rosters seen, systems are in place to ensure residents’ needs are mainly met by a mix of qualified and care staff with a commitment to specific and NVQ training. Additional staff could improve residents’ quality of life. Residents are protected by robust recruitment procedures. Younger Adults Respite Unit. Clients are supported by a staff team who are interested and motivated to provide a good standard of care. Clients are protected by robust recruitment procedures and a new induction programme. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 26 EVIDENCE: Older Persons Residential Unit. The home currently has 91 care hours per week vacant plus 20 activities coordinator hours (temporary). All have been advertised and the acting manager is hopeful to appoint to these post in the very near future. These vacancies have meant that a high number of agency hours have been worked recently but staff confirm they normally use the same agency staff, so that they are familiar with the home. Most staff stated they felt sufficient staffing hours were used although some residents said staff were to busy and were rushed off their feet. One commented ‘it does not leave them any time just to sit and talk to me’. Staff files evidence that the home has robust recruitment procedures in place and all staff files viewed held the required information. Since the last inspection the home now has three waking night staff. The home no longer has a Team Leader on sleeping in duties. This is in line with other homes that Medway Council manage. On the whole training records and discussion with staff showed that training was comprehensive and consistent. However it was noted that the home did not carry out an appropriate induction procedure with records kept. A requirement has been made regarding this. It is recognised that some work had been completed around this issue but the requirement will remain until the home can fully evidence sound induction procedures. A requirement was also previously made regarding dementia awareness training. Again some work has been completed but all staff would benefit from this training. The home currently has 32 out of 34 staff qualified to at least NVQ level 2. All team leaders hold NVQ level 3 plus a full first Aid at Work certificate Younger Adults Respite Unit. Service users and staff spoken to felt that staffing levels were good, although some agency staff are currently being used. Training records on the whole were very good and it was clear from feedback from staff that they are encouraged by the manager to undertake personal development and training. Medway council’s comprehensive training programmes support this. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 27 The manager has developed an induction programme that is comprehensive. The latest member of staff to be employed is currently undertaking the course and says it has helped her to settle in and provides her with the confidence to meet the requirements of her job. Part if the induction programmes enables the manager to review the care workers progress after one week, one month and then after six months, when the normal probation period is over. The manager signs the record at each stage to confirm competencies. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 37 and 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 29 Older Persons Residential Unit. The management of the service is compromised because the Registered Manager is absent. Because of the identified management shortfalls, the health, safety and welfare of service users and staff are not always fully promoted and protected. Younger Adults Respite Unit. Clients and staff benefit from a well-managed service, which ensures that the health, safety and welfare of service users and staff are promoted and protected. EVIDENCE: Older Persons Residential Unit. The registered managers continuing absence is having a negative effect on the safe management of the home. Although the home currently has an acting manager in post, this has only happened recently. Changes in the next level of management have also occurred. The registered provider is strongly advised to ensure the current situation is resolved quickly to enable the home to improve it current poor rating. Issue with care planning and medication administration are evidence that management control has been lacking. The acting manager is aware of the problems within the home and is currently working hard to restore confidence and competence within the senior team. Staff says she is approachable and shows good leadership skills. However it is recognised it is difficult to manage when it is a temporary situation. The inspector does recognise that she is putting every effort into addressing the problems. Quality assurance was discussed with the acting manager who confirming the previous manager had started to instigate a system but that full compliance with standard 33 has not been completed. She gave assurances that it is her intention to complete the quality assurance and quality monitoring systems and produce a report. This report will then be used to inform future annual development plans and actions. Although at the last inspection Medway Council advised the inspector that a new central service user finance system was in the process of being introduced. This still has not happened at Robert Bean Lodge. The new system, when introduced, will comply with this standard. The outstanding requirement will remain in place until met. Clearly the system has not been rolled out to individual home’s as yet and the registered person is again asked to identify timescales in the home’s improvement plan for this work to be completed. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 30 The acting manager has started to supervise senior staff and is confident other staff are receiving regular supervision. It is strongly advised that supervision is monitored within the home and records are kept to evidence this. As stated previously service user assessments and care planning was not appropriately maintained and consequently health, personal and social care needs were not adequately met. Records showed that the home is being maintained appropriately internally and the health and safety of service users in this respect is being upheld, however external maintenance is poor. Some discussion took place over the written fire drill and whether the home actually practises full evacuation as stated in its statement of purpose. The acting manager is asked to clarify the procedure and to inform staff and the commission if changes have occurred. The statement of purpose will also need to be amended if necessary. Younger Adults Respite Unit. Staff and service users spoken to felt supported by the manager and found her approachable. It was clear that she had a good understanding of service users needs and her relationship with relatives in the best interests of service users was observed to be excellent. Staff confirmed that supervision is taking place and the recording of the staff supervision has improved. Service user risk assessments were in place and the unit was maintained to ensure service users safety. However the inappropriateness of the building is putting clients at risk and is limiting their opportunities to maintain independence and freedom of choice. It is recognised that staff make every effort to ensure clients enjoy their respite stay and are physically well cared for. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 31 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 2 3 3 1 4 2 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 1 20 X 21 2 22 X 23 2 24 X 25 X 26 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 1 32 2 33 1 34 X 35 1 36 2 37 1 38 2 Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 32 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP35 Regulation 20(1a) Requirement The registered person shall not pay money belonging to a service user into an account unless the account is in the name of the service user or any of the service users to which the money belongs. This requirement has been carried over from the last two inspections. Previous timescale: 20/10/06 Improvement plan required 2. OP36 18.1(c) (I) & 18.2 The registered person must ensure that the recording and undertaking of supervision and in particular, staff induction, in the elderly services is carried out. This requirement has been carried over from the last inspection. Previous timescale: 20/10/06 Improvement plan required Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 33 Timescale for action 09/07/07 09/07/07 3. YA24 23.1 (a) (b)&2(a) The registered person must provide the Commission with an action plan detailing when the Younger Adults Respite Service will be re located including time scales. This requirement has been carried over from the last two inspections. Previous timescale: 20/10/06 Improvement plan required 09/07/07 4. YA17 16.2 (h) The registered person must ensure that the younger adults service has appropriate facilities for them to be involved in shopping, cooking and preparing their own food. This requirement has been carried over from the last two inspections. Previous timescale: 20/10/06 Improvement plan required The registered person must ensure that the younger adults service has a bath with appropriate adaptations to meet service users needs. Previous timescale: 20/10/06 This requirement has been carried over from the last two inspections. Previous timescale: 20/10/06 Improvement plan required 09/07/07 5. YA27 23.2 (n) 09/07/07 6. OP3 14.1 & 2 15.1 The registered person must ensure that elderly residents health, personal and social care DS0000036756.V341653.R01.S.doc 09/07/07 Robert Bean Lodge Version 5.2 Page 34 needs are properly assessed and met. This requirement has been carried over from the last inspection. Previous timescale: 20/10/06 Improvement plan required 7. OP7 15 and schedule 3 The registered person must ensure that each service users health, personal and social care needs are set out in an individual plan of care. Improvement plan required 8 OP19 23(2)(o)(n) The registered person must 09/07/07 ensure service users live in a safe, well maintained environment in that the gardens and pathways are suitably maintained. 13(2)(3) The registered person must 11/06/07 17(1)(a) ensure that staff who administer Schedule 3 medication follow the home’s policies and procedures. 09/07/07 9 OP9 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. Refer to Standard OP35 Good Practice Recommendations The following is recommended: Southampton City Council have managed to find a good solution to the issue around Reg 20, and the need to avoid pooling service user monies. The system theyre adopting is called Clients Monies Service (CMS) from Nat West. It involves one account, with separate sub-accounts within it. The subaccounts carry their own number and are interest bearing, therefore ensuring interest is calculated on the amount in each account etc. Monies can be managed in relation to each sub-account by the authoritys finance department DS0000036756.V341653.R01.S.doc Version 5.2 Page 35 Robert Bean Lodge through a modem link to the bank. 2. OP12 It is recommended that the home employ an activities co- coordinator who is trained to undertake exercise groups and other activities that she may be required to facilitate. It is recommended that the home provide organised activities. It is recommended that effective assurance and quality monitoring systems be put in place to ensure the views of service users are sought and taken into consideration. It is strongly recommended that staff who are responsible for administering medication be regularly assessed for continuing competency. 3. 4 5. OP12 OP33 OP9 Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © 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. Robert Bean Lodge DS0000036756.V341653.R01.S.doc Version 5.2 Page 37 - 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. 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