Inspection on 08/05/08 for Robert Bean Lodge

This inspection was carried out on 8th May 2008.

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

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

Other inspections for this house

Robert Bean Lodge 30/05/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Robert Bean Lodge Pattens Lane Rochester Kent ME1 2QT Lead Inspector Elizabeth Baker Unannounced Inspection 8th May 2008 09:50 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 Robert Bean Lodge DS0000036756.V363461.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. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Robert Bean Lodge Address Pattens Lane Rochester Kent ME1 2QT 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) 01634 831122 01634 831113 ann.togwell@medway.gov.uk 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.V363461.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 30th May 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 10 bedrooms and separate day space. Medway Council runs the establishment, which is registered for 40 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 four persons and is self-contained with its own staff team. The accommodation is known as the Napier Unit. The current weekly fee for residents staying at Robert Bean Lodge is £387.00. Additional fees are charged for hairdressing, toiletries, newspapers and chiropody. The current range of Robert Bean Lodge activities include music, sing-a-longs, arts and crafts and bingo. Current fees for Napier Unit residents are dependent on the level of benefit being paid and their assessed individual needs. They range from £9.00 to £30.00 per night, inclusive. And for Napier Unit residents current activities include visits to shops, pubs and libraries, as well as to their respective day centres. A Church of England service takes place at the home monthly. The inspection report is available in the reception area. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means people who use this service experience adequate quality outcomes. Link inspector Elizabeth Baker carried out the key unannounced visit to the service on 8 and 9 May 2008. In total the visit lasted about 11½ hours. As well as briefly touring the home, the visit consisted of talking with some residents, visitors and staff. Four residents, four members of staff and three visitors were interviewed in private. Verbal feedback of the visit was provided to the acting home manager and unit manager during and at the end of the visit. At the time of compiling the report, in support of the visit, we (the Commission) received survey forms about the service from 34 residents, two care managers, four healthcare professionals and 16 members of staff. At our request the home completed and returned the home’s Annual Quality Assurance Assessment (AQAA). Some of the information gathered from these sources has been incorporated into the report. This key unannounced visit coincided with a specific thematic inspection. We periodically undertake these as part of our methodology for assessing particular standards. The theme focused on safeguarding. Although the visit to Robert Bean Lodge was a key unannounced visit, the information gathered from Standards 18 and 29 will also be used as part of a wider investigation that we are doing about how well services are managing safeguarding issues, for the protection of residents. We have not received any complaints about the service. The AQAA records there have been two safeguarding adult referrals. These would have been investigated under the county’s safeguarding adult procedures. What the service does well: Both the acting manager and unit manager were receptive to advice given and eager to put right matters needing addressing. Staff are enthusiastic about their roles and enjoy working at the home. Residents enjoy appetising and varied meals. Both the acting manager and unit manager promote an open atmosphere and residents, staff and relatives are appreciative of this. The provider is committed to ensuring all care staff are NVQ level II trained with nearly 100 of staff having attained this. Compliments and comments received from survey respondents included “Overall excellent standard of care for clients”; “Thoughtful, warm, professional care to meet the needs of the individual”, “The provision of high quality respite care to meet individual Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 6 needs”, “In my experience [the service] provides good respite care”, “The staff are always pleasant and very help, I have no problems with the care that service user receives when staying at the home”, “My son has severe physical and learning difficulties and attends the home for respite care. He always appears happy and well cared for, although unable to speak for himself”, “Meals are always hot and we have a choice”, “The home looks after us well – no complaints”; “The food is excellent and the home is very clean and tidy – 100 ”, and “The home is always nice and clean”. What has improved since the last inspection? What they could do better: Care plans must contain more details of residents’ individual assessed needs, wishes and aspirations, the action to be taken and goals to be achieved in order reflect person centred care. For residents’ safety, all care staff must receive training to reflect the assessed needs of current and future residents including Parkinson’s disease and diabetes. For safeguarding purposes, references must be sought from previous care employers where this is appropriate to the individual applicant. The range of clinical risk assessments for monitoring residents’ conditions must be expanded to include nutrition, oral hygiene, continence and pain. All residents must be provided with a moving and handling assessment, for their safety as well as staff’s. For equality purposes, residents residing on Napier Unit must be provided with accommodation appropriate to their needs, in line with those residents residing at Robert Bean Lodge. This includes bathrooms and day space. The provider must ensure that his representative visits the home on a monthly basis and provide the home with a report of the findings. A comment card respondent added the service could improve by “Monitoring regularly for weight loss, blood sugar glucose and blood pressure” [Robert Bean Lodge] and “More space Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 7 [Napier Unit]”. Three requirements have been made and a number of good practice recommendations have been made throughout the body of the report. 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.V363461.R01.S.doc Version 5.2 Page 8 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 Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Systems are in place to determine prospective residents’ suitability to be admitted into the home, although more recorded detail for Robert Bean Lodge residents would enhance the process further. EVIDENCE: Following a period of public consultation, the home is now in a transition stage, which should eventually change the whole registration of the service. The new service will incorporate a new discrete unit for up to eight younger adults with complex needs. The remaining beds will be registered for older people requiring personal and dementia care. Until the exercise is completed only older people requiring respite care are now being admitted into Robert Bean Lodge. Since the last visit the acting manager has reviewed the home’s main statement of purpose and service user guide to reflect the position and the document is available in draft format. In order that it fully reflects what is Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 10 required to be included, such as precise details of bedroom sizes, it is suggested the document is reviewed in accordance with our guidance on the contents of statement of purpose. This is available on our website and may prove useful during the home’s development stage. A separate service user guide in a suitable format is available for residents admitted into the Napier Unit. This reflects the diversity of the residents using this unit. For residents residing in the older people’s unit, staff endeavour to undertake pre admission visits to assess prospective residents’ condition in their current environment. Where this is not the case, staff rely on information provided by care managers. Information taken from pre admission assessments is used to inform the respective admission assessment and corresponding care plan. However not all the information is transferred to the admission assessment, resulting in corresponding care plans not wholly reflecting all the assessed needs. Napier Unit residents and or their advocates are required to complete a learning disability referral pack. This is supplemented by a full needs assessment supplied by the resident’s care manager. The information is also used to inform the residents corresponding care plan. Care plans are reviewed on each admission and updated accordingly. Care managers also review their younger clients on a six monthly basis. The information gathered is shared with the home, as well as the residents’ main carers. The home is not registered for intermediate care. Standard 6 is not applicable. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. The health and personal care needs of residents are generally met with evidence of multi-disciplinary working taking place when required. Robert Bean Lodge residents may be at risk of not receiving appropriate care due to insufficient information being gained and/or transferred to the care plans. EVIDENCE: Five care plans were reviewed, four of which related to residents on Robert Bean Lodge. Not all of the Robert Bean care plans provided a complete picture of the residents’ assessed needs and the care to be delivered. The current care plan format used on Robert Bean Lodge does not promote full details be recorded of the actual need/problem, outcome/goal to be achieved and action to be taken. Where care managers and advocates had provided good information on residents this was not always reflected in the corresponding care plan. For example where some medical problems had been included on the front sheet of the care plan record, this information had not triggered individual care plan components such as pain, osteoporosis, heart problems, Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 12 high blood pressure, sleep apnoea, incontinence, cognitive impairment and depression. During an interview with a resident it transpired the resident couldn’t eat their preferred meals because of oral problems. The corresponding care plan did not include this information. There was no oral hygiene or nutritional assessment either. The resident described a pain site. But there was no corresponding pain care plan component or pain assessment to monitor the progress of the treatment. The resident’s emotional state was not reflected in the care plan either. The resident was anxious about having physiotherapy to improve their mobility. And a reference to physiotherapy was seen in their care plan. However there was no recorded evidence that a referral had actually been made. Another resident described how they enjoyed their showers and was under the impression that there is a ‘home rule’ permitting only one shower a week. Their corresponding care plan made no reference to frequency of baths or showers, but just included a tick. One of the four care records seen did not include a moving and handling assessment. For the safety of residents and staff, all residents must be assessed as to their moving and handling needs. Personal clothing records were seen. However in one case the information related to the resident’s previous stay at the home. There was no recorded evidence it had been updated to reflect the current stay. The care plan on Napier unit was more informative and provided a clearer picture of the resident’s needs and the care being delivered. However where a reference to administer when required (PRN) medication was seen in a medication administration record chart (MAR) the corresponding care plan referred to medicines being administered as prescribed by the GP. It is good practice to include full details in residents’ care records of when to administer such medications. Daily records are maintained on all residents and generally gave a brief description of their quality of day experiences. By choice residents are able to self-medicate, although most residents prefer staff to administer their medications for them. For residents’ safety a selfmedication assessment is undertaken where residents prefer to self-medicate. In respect of a newly admitted respite resident their advocate had provided good information on the resident’s medicines. However a review of the assessment in use did not fully evidence it had been undertaken with input from other people involved in the resident’s care such as the GP, advocate and care manager, where appropriate. Robert Bean Lodge has a medical room, which incorporates a drug room. This is suitably equipped for safely storing medicines and includes a drug fridge. Temperatures of the drug fridge are maintained. However it was identified that the room temperature is not monitored. Indeed a member of staff said the room always feels warm. To ensure the efficacy of medicines is not Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 13 compromised, medicines must be stored in accordance with manufacturers instructions with regards to temperatures. Monitoring and recording the room temperature is a means to achieving this. Generally MAR charts had been completed as required. However not all handwritten transcription entries had been signed by the transcriber or countersigned by a witness in accordance with good practice. Good interaction was seen between residents and staff. Residents were seen appropriately dressed for the time of day and season, with attention to detail where this is important to them. Residents spoken with indicated staff treat them with respect when assisting them with their personal hygiene care needs. Care records did not adequately include details of residents’ spiritual and cultural wishes and preferences in relation to death and dying. While recognising this is a sensitive subject, it is an important aspect of care and needs to be addressed. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Not all residents are supported in attaining their life style preferences. Meals offer both choice and variety. EVIDENCE: Arrangements are made for residents to take part in structured activities, socialise with others and or to be as independent as possible. Special occasions are celebrated with a cake and tea party. Residents spoken with indicated they spent their time as they wished to. This includes participating in communal activities such as sing-a-longs, gardening, attending the monthly Church of England service. The spiritual needs of other residents are met by visiting lay people from other denominations. Some residents like to spend their time in the privacy of their rooms listening to the radio or reading their newspapers. Some of the younger residents are supported in going out to the pub, shops or libraries. A number of residents join in activities in the associated day centre. At the time of the visit residents from both units were enjoying the good weather by sitting out in the different courtyards. And a BBQ was being arranged for the younger adults for the forthcoming weekend. The Napier unit manager is trying to organise the use of a vehicle so residents Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 15 can go out and about at weekends during the summer period. And all the younger adults are assisted in attending their respective day centres during the week. Despite the above, nine comment card respondents indicated there is not always enough for them to do with their time. These were in relation to Robert Bean Lodge. And one respondent added, “I do not think there is much going on with regards to activities”. Life history sheets were seen in the care plans of Robert Bean Lodge residents. Disappointingly two were blank and the others contained minimal information. This situation does not assist activity coordinators in devising activities to meet the diverse needs and wishes of all residents. Residents can choose to have their meals in the dining rooms or in the privacy of their rooms. Sadly residents on Napier unit have to share their dining room with staff, as this also serves as an office. Although meals were not sampled on this visit, appetising and well-presented meals were seen on both units. Residents spoken with indicated they enjoyed their meals and a visitor eating their meal with their relative said the meal was very good. Special diets are catered for and the chef meets with residents with specific preferences to ensure they receive the meals of their liking. This includes vegetarian dishes. For younger adults it is good practice to encourage them to participate in meal preparation, where their assessed needs allow this, or indeed they wish to. However because of the current arrangements, they are prevented from doing so as the home’s one kitchen is out of bounds to them. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents and their advocates know their complaints are listened to and acted upon. EVIDENCE: An information booklet advising residents, visitors and staff about the home’s complaints procedure is available at the home. The procedure includes our details. The statement of purpose for both Robert Bean Lodge and Napier Unit include details of the complaints procedure. The complaints procedure for Napier Unit is in a suitable format for its residents. Residents and visitors spoken with described the action they would take if they had a concern or complaint. Staff interviewed all indicated they had not received specific safeguarding adults training, but this subject was included as part of their NVQ training course. However during discussions with both managers it transpired that all staff are booked to attend safeguarding adults training soon. Staff were able to describe appropriately the action they would take if they suspected abuse had taken place and had a good understanding of what constitutes abuse. The acting home manager has received specific safeguarding training for her role. Information about whistle blowing was seen displayed in various parts of the home. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 17 We have not received any complaints about the service. The returned AQAA indicates that in the last 12 months the home has received no complaints. The form also indicates the home has made two safeguarding adults referrals which were investigated under the county’s safeguarding adults procedures. Each unit maintains a complaints record book in which formal written complaints would be kept. However it has not been the home’s practice to record centrally details of any “informal” complaints and or niggles. Having such a system may provide the home with a more effective way of auditing trends for quality assurance purposes. The home has procedures for the reporting of safeguarding adult matters. Arrangements are made so residents can exercise their civil rights by voting in elections. This is good practice as some residents spoken with indicated this is important to them. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22 and 26. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. The proposed environmental changes and refurbishment of the home should enhance the quality of life for all residents living there. All residents live in a clean and fresh environment. EVIDENCE: In April 2005 four bedrooms, which had been converted from surplus office accommodation into specific accommodation for four older people requiring respite care, were registered with us for the temporary use of four younger adults requiring personal respite care. This followed the urgent closure of their care home. Some of the younger people using this respite service have complex needs, which require the use of special equipment and aids. However the current arrangement does not provide the four younger people with appropriate accommodation in that their dining room is also used as an Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 19 office, the assisted bath is not suitable for all their assessed needs and, as mentioned previously, facilities promoting independence such as using the kitchen to assist in meal preparation is out of bounds. To resolve the problem in December 2007 the provider submitted plans to convert one 10 bedded unit into a discrete permanent facility for younger adults requiring personal respite care. This will have consequences for the rest of the home. A public consultation has taken place and all current residents and or their advocates have been informed of the plans. To meet the diverse physical needs of residents at the home, the home has a range of lifting and moving equipment, including overhead tracking. Where there is an assessed need, special rise and tilt beds are provided. Airflow mattresses are provided on an assessed needs basis via District Nurses. And a mobile loop system is available to any resident requiring this aid. The home’s corridors are wide and are fitted with handrails, assisting independent residents moving safely around the home. Areas visited and used by residents were fresh, clean and odour free. Indeed residents and visitors spoken with indicated the home is always kept in a clean condition. An environmental health inspection of the home’s kitchen was carried out on the 2 August 2007 followed by a mentoring visit on the 6 August 2007. The acting manager stated the requirements have been met. As is required under Workplace Fire Precautions Legislation, the home has a current fire risk assessment. This resulted in a fire safety officer issuing an action plan. The acting manager said all the recommendations have been complied with. The home has recently forged links with a garden project team and the arrangement begins in June. This should ensure that lawns, borders, flowerbeds and courtyards are maintained in a good and safe order for residents’ enjoyment. Garden contractors had been used on a recent occasion to cut the lawns around the site. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Residents who use the service experience good outcomes. This judgement has been made using a range of evidence including a site visit to this service. Residents receive care from an enthusiastic, caring and trained workforce, although more specific training would enhance this. EVIDENCE: As well as care staff, staff are employed for cooking, activities, cleaning, laundry, administration and maintenance. Staff were seen carrying out their duties in an unhurried manner and being attentive to residents. Comment card respondents added “There are always staff around when you need them” and “The staff are mostly very busy but manage to do a very good job”. Staff working on the Napier Unit receive training reflecting the assessed needs of the current residents, including peg feeding. However this is not always the case for staff working at Robert Bean Lodge. For example some current residents have medical conditions such as Parkinson’s decease and diabetes. However staff have not received training on these subjects. All staff are required and receive mandatory training on subjects including, fire, health and safety and moving and handling. The AQAA records that 93 of staff are currently trained to NVQ level II or above in care. This is good practice. Staff on both the Napier Unit and Robert Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 21 Bean Lodge are required to work through an induction programme. Records are maintained as evidence of the work completed. However the Robert Bean Lodge records were not so comprehensive as the one seen for the Napier Unit. The personnel files of three members of staff were inspected. New staff are required to complete an application form, provide details of two referees and undertake a Criminal Record Bureau check. Two references had been obtained in all three cases. However for a particular member of staff who had previously worked in a care environment, a reference had not been sought from the care employer. Whilst recognising that this care employment was not the most recent, Regulation 19(Schedule 2) paragraphs 3 and 4 requires that two written references, including where applicable a reference relating to the person’s last period of employment which involved work with children or vulnerable adults, of not less than three months duration be obtained. According to the application form the care employment lasted about 20 months. During 2006 we published guidance to assist providers in the development of their recruitment procedures and practices. The publications in question are called Safe and Sound? Checking the suitability of new care staff in regulated social care services and Better safe than sorry – Improving the system that safeguards adults living in care homes. Both documents can obtained from our website – www.csci.org.uk. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Residents who use the service experience adequate outcomes. This judgement has been made using a range of evidence including a site visit to this service. Management are pro-actively improving this service for the benefit of residents. The management of the service, in relation to records, potentially puts some residents at risk. EVIDENCE: The acting home manager of Robert Bean Lodge is experienced in working with older people with personal care needs. An experienced unit manager who has responsibilities for other Medway Council services providing care for younger adults runs the Napier Unit. Residents, visitors and staff spoke openly during the visit about their experiences of visiting, living and working at the home. Comment card respondents additional comments about the home’s management include “My manager supports staff to further their knowledge and career prospects with additional training. We are given training on Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 23 equality issues and we work very well as a team”, “We are all NVQ II trained at the least and new staff are fully supported by experienced staff and our manager. We have job satisfaction”; “I had an excellent induction, we are always given up to date training or information of training. If we do have any problems we only have to ask the team leader or managers who will always give us advice” and “We have mandatory training courses which have to keep updated. We have leaflets to pass on to people about concerns plus access to phone numbers of people that they can speak to” and “My manager is brilliant”. Formal supervision has been introduced and recorded notes are maintained. However there has been some slippage in the frequency of sessions on Robert Bean Lodge, which the acting manager is trying to rectify. Following the last visit the acting manager instigated a satisfaction survey. However the collating and analysing of responses was not completed due to management changes. The acting manager is going to repeat the survey and ensure it is concluded as part of the home’s overall quality assurance programme. This should help the home establish any areas that may need improving. Indeed activities might be one area in that nine of the 32 of surveys received from residents in support of this visit, indicated to us the home’s activities were not wholly to their liking. The provider’s representative visits the home and provides a report of the findings. However these are not always done on a monthly basis as is required by regulation. Staff and residents meetings take place. Napier Unit staff contact advocates and or carers following the return home of respite residents to establish whether there are any matters that need discussing or explaining. This is good practice as a means of obtaining feedback for quality assurance purposes. We have now reached an agreement with the provider in respect of managing residents’ personal monies, where this facility is required. The maximum held will not exceed £100.00 per resident. Where this amount is exceeded, the balance is returned to the resident or their advocate for their safekeeping. Each resident is provided with an internal account, which has an individual identification number. Individual records of all transactions are maintained. Receipts are obtained for services provided or items acquired on residents’ behalf. The records are subject to regular auditing by the provider. The home has sit on weighing scales for residents use. However it was noted on this visit that they are not routinely calibrated. To ensure residents weights are effectively monitored the scales should be calibrated in accordance with the manufacturers instructions. As stated previously, not all records relating to residents were complete and up to date to demonstrate all their needs, risks and preferences had been properly assessed and recorded. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 24 The AQAA records that maintenance of the home’s equipment is serviced or tested as recommended by the manufacturer or other regulatory body. The AQAA also records the home has policies and procedures for staff to refer to when carrying out particular duties. Apart from the safeguarding adults and the prevention of abuse and First Aid, which are recorded as last being updated in May 2005 and February 2003 respectively, policies were reviewed in April 2008. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 25 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 1 X 2 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 2 2 Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) 13(5) Requirement Timescale for action 2 OP27 18(1)(c) Unless it is impracticable to carry out such consultation, the registered person shall, after 31/08/08 consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. This must reflect all known assessed needs, including pain, sleep, incontinence, cognitive impairment, depression, heart problems, nutrition, diabetes and oral hygiene. All care plans must also include a moving handling risk assessment. The registered person shall 31/08/08 having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. The training must reflect the assessed needs of current and future residents DS0000036756.V363461.R01.S.doc Version 5.2 Page 27 Robert Bean Lodge 3 OP33 YA39 26(2) for conditions such as Parkinson’s disease and diabetes. Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by an employee of the organisation or the partnership who is not directly concerned with the conduct of the care home and the visits shall take place at least once a month and shall be unannounced. 31/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP8 Good Practice Recommendations It is strongly recommended that the home’s pre admission and admission assessments cover all the prompts set out in standard 3.3 of NMS for Care Homes for Older People It is strongly recommended that the range of clinical risk assessments is expanded cover pain, nutrition, oral hygiene and continence so that treatment plans can be effectively monitored. Robert Bean Lodge DS0000036756.V363461.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone 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.V363461.R01.S.doc Version 5.2 Page 29 - 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. 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