Inspection on 03/02/06 for Saxon Lodge

This inspection was carried out on 3rd February 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Saxon Lodge 05/07/06

Saxon Lodge 12/10/05

Saxon Lodge 08/10/04

Saxon Lodge 07/06/04

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 HOMES FOR OLDER PEOPLE Saxon Lodge 30 Western Avenue Bridge Canterbury Kent CT4 5LT Lead Inspector Nicki Dawson Unannounced Inspection 3rd February 2006 9:15 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 Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 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. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Saxon Lodge Address 30 Western Avenue Bridge Canterbury Kent CT4 5LT 01227 831737 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) Saxon Lodge Residential Home Limited Miss Wendy Richards Care Home 18 Category(ies) of Learning disability over 65 years of age (1), Old registration, with number age, not falling within any other category (17) of places Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. LD (E) is restricted to one (1) person whose date of birth is 24.07.1932 12th October 2005 Date of last inspection Brief Description of the Service: Saxon Lodge is a residential care home, providing care for up to eighteen people over the age of 65 years. There is a variation to the condition of registration that allows for one person with a learning disability. The home is situated in a quiet road, in the rural village of Bridge. Amenities in the village include a small supermarket, post office, newsagent, chemist, two churches and a number of public houses. Canterbury, Dover and Folkestone are all within ½ an hour drive of the home. The home is managed by Wendy Richards. Resident’s accommodation is provided over two floors with a lift for easy access. All bedrooms are single rooms and six of these are ensuite. A lounge, conservatory and dinning room are the communal rooms available to all residents. There is a bathroom, shower room and three additional toilets on the ground floor and two toilets on the first floor. There is a garden to the rear of the property, which is paved in part to enable residents to walk in the garden. There are plans to extend the home to provide accommodation for an additional five residents. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection commenced at 9.15 and lasted for just under 6 hours. The inspector observed staff interactions with residents in the dining room and the lounge and spoke to four residents and one relative. The inspector received information about the service from four relatives and one care manager, prior to the inspection. The two care staff on duty were also spoken with and the inspector was given a tour of the home. The rest of the time was spent in the office talking with the deputy manager and looking at records. The inspector made a follow-up telephone call to the registered manager following the inspection. 83 of the relatives/professionals who were contacted prior or during the inspection stated that they were satisfied with the overall care provided by the home. What the service does well: What has improved since the last inspection? What they could do better: The home does not promote improvement in the service by actively seeking the views of the residents whom it accommodates. This, together with an effective complaints procedure would ensure that the home is run according to the best interests of the residents. Although no evidence was found that any residents had been put at risk, the recording of the administration of medication needs to be improved to minimise this potential risk. The policies and practices around the protection of vulnerable adults need to be developed to ensure the safety of all residents. The environment needs to be made secure to ensure that residents who have a tendency to wander are not put at unacceptable risk. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 6 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. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5 Information given to prospective residents is helpful in assisting them to make an informed choice about where to live and needs limited up dating to ensure that it is current. Prospective residents are given an opportunity to visit the home before admission. Preadmission assessments should be undertaken in a timelier manner to ensure that all residents needs can be met, before they enter the home. EVIDENCE: The home has produced a ‘Statement of Purpose’ that sets out the aims, objectives and philosophy of the home, together with the services and facilities provided for residents. The home is also required to produce a ‘Service User’s Guide’, which clearly sets out for residents (in a format that has meaning to them) the services and facilities that they can expect if they move to the home. Each prospective and current resident should be given a copy of this guide. This guide is easy to read. Both documents require a limited amount of information to be up dated. It would also be helpful to readers to include the current staff-training programme in the staff qualifications section. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 9 The deputy manager explained the admissions procedure for a resident who had recently been admitted to the home. The registered owner assessed the needs of the prospective resident. The resident had the opportunity to visit the home with their family and stay for a day before deciding whether the home met their needs. Records indicated that an initial assessment was undertaken the day after the resident was admitted to the home. It is good practice to complete the initial assessment prior to admission, when this is practicable. The registered person has applied to the Commission for Social Care Inspection to vary their registration to care for three residents who have been diagnosed with dementia, since moving to the home. Just over half of the care staff team have been trained in caring for people with dementia and a third of the staff team have received training in caring for people with challenging behaviours. The home has a rolling staff programme to ensure that all staff are trained in these two areas. In order to ensure the safety of residents who have a tendency to wander, it is required that the home fit an alarm on the ground floor fire door that leads out onto the street. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 11 There has been some improvement in the writing of individual’s plans of care, but they need further development to ensure that all resident’s needs are met. Some changes need to be made in the recording of the administration of medications to ensure that residents are protected by the homes procedures. Staff treat residents in a sensitive manner in times of illness and death. EVIDENCE: A selection of resident’s individual plans of care was sampled. The plans begin by giving a ‘pen picture’ of the resident, followed by information about the resident’s personal care, health care and social care needs. After each section, there is a summary which details what action needs to be taken by staff to meet the residents assessed needs. This information needs to be expanded, especially in relation to some residents who present behaviours that challenge. Staff complete daily report sheets, which detail how each residents care needs are met on a daily basis. Individual plans of care are reviewed on a monthly basis by staff and regularly by the deputy manager. This information is now being transferred to the original plan of care, ensuring that the care plan contains the most up to date information. Staff had a good understanding of the care needs of residents and the majority of relatives said that they were kept informed of any changes in their relatives care needs. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 11 Resident’s health care needs are clearly recorded in their individual plans of care. Resident’s health is monitored and promoted by keeping clear records of all health care appointments and treatments and also by keeping a discrete eye on residents’ nutritional intake. Basic assessments of the potential risks to residents have been completed, but require further development to include the action to be taken to minimise the potential risk to the resident concerned. Selected aspects of the ordering, storage and administration of medications were inspected. Staff were observed administering medication to residents in a professional manner. The home has a rolling programme of training in operation to ensure that all staff receive external training in the administration of medication. A number of improvements in the recording of the administration of medication were discussed with the deputy manager, who agreed to put them into practice with her staff team. These statutory requirements relate to staff consistently recording the amount of medicines received into the home; countersigning handwritten entries and discontinued medication; disposing of one unused ‘when required’ medication; and ensuring that one resident receives their eye drops on a daily basis. Staff demonstrated their competence and knowledge of caring for residents that are ill or dying. A number of care staff has attended training in loss and bereavement. The bereavement wishes of residents are recorded in their individual plan of care. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 Residents are able to maintain contact with family and friends and are offered social and recreational activities. EVIDENCE: There is an activities coordinator in post who works at the home one day a week. Residents explained how they had enjoyed making valentines cards with the activities coordinator the previous day. Unfortunately, the clay modelling activity is still not possible due to imminent building work. Residents said that they were encouraged to take part in regular armchair exercises. A visiting professional commented that, “there are interesting activities at the home”. Resident’s, who are able, are encouraged to maintain their independence in visiting the local shops. When staffing levels permit, residents are escorted on short walks in the village. During the inspection a number of relatives were observed visiting their relatives and some residents were going out with family. Relatives observed that they were always welcomed when they visited the home. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has taken the first steps towards showing their commitment to listening and acting upon complaints. Staff have an understanding of the issues surrounding the protection of vulnerable adults, but the home needs to develop its policy and practice in this area. EVIDENCE: Relatives commented that they were aware of the home’s complaints procedure. The complaints book was not available on the day of the inspection, but a copy of all complaints received, was sent to the Commission as requested. The complaint format allows for the compliant to be recorded, together with the action taken to address the compliant. The complaints records show that one compliant has been dealt with effectively by the home and that another complaint is currently being processed. The importance of recording all complaints, whatever their nature was discussed with the registered manager who agreed that this was an effective way of promoting a culture in which residents and relatives views are taken seriously and acted upon. There is a rolling staff-training programme to ensure that all staff receive training in the protection of vulnerable adults. Staff demonstrated that they would report any suspicion of abuse. The complexity of incidents of physical or verbal aggression between residents was discussed in detail with the registered manager and deputy manager. Any such incidents are recorded in residents care notes. It is recommended good practice that these incidents are also recorded on an incident form. There is a policy on elder abuse, but it is not comprehensive and does not include the situations in which an incident should Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 14 be referred to the local authority, or include the action to be taken when there is physical or verbal aggression between residents. The registered manager stated that she had obtained a copy of the Kent and Medway Adult Protection Guidance and that she would use this to inform the home’s policy and procedures. There is a ‘whistle-blowing’ policy for staff. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26 Saxon Lodge provides a clean and comfortable environment for the residents that it accommodates. Plans are in place to undertake building work to enhance the facilities offered to residents. The laundry procedure and practices need to be updated to ensure that the home is hygienic. EVIDENCE: Saxon Lodge is situated in a quiet road, in the rural village of Bridge. Residents are provided with a lounge and conservatory to sit in during the day. During the inspection however, the conservatory was not in use since it was too cold. There is also a separate dining room where residents take their meals. Plans have been submitted to the Commission for Social Care Inspection to build six additional ensuite rooms in what is currently the garden and to extend the lounge where the conservatory is currently situated. A number of resident’s rooms were viewed and were decorated according to individual needs and tastes. There is a bathroom with a hoist and an adapted toilet on the ground floor to assist those residents with mobility problems. A shaft lift provides access between floors. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 16 Generally the furnishings of the home meet the resident’s needs. It was disappointing to learn however, that the tiling in two ensuite bathrooms on the ground floor has yet to be completed. This was highlighted at the last inspection. The home was clean and pleasantly odoured on the day of the inspection. The laundry policy was discussed with the deputy manager and she agreed to update it to ensure that there is no cross infection between clean and foul laundry. It was pleasing to see that the clinical waste bin has now been secured in the garden. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 A staff-training programme has been developed for the whole staff team, but it does not yet include induction training to a nationally recognised standard. EVIDENCE: The registered manager confirmed that although new staff receive induction training it does not currently meet the National Training Organisation workforce targets. A training matrix has now been produced for the whole staff team, which details which training each staff member has undertaken. During the inspection staff said that they had gained a better understanding of their role within the home, by undertaking relevant training courses. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 36 and 38 It is not clear whether the home is run in the best interests of residents, since there is no quality assurance system in place that seeks their views of the service. Policies and procedures are in place to protect the welfare of residents, but specific action needs to be taken to reduce the risk of vulnerable residents leaving the home without the prior knowledge of staff. EVIDENCE: The home does not currently have an effective quality assurance system in place, nor has it done so for some time. It was noted at an inspection in 2004 that a questionnaire to ascertain residents views had not been completed any later that 2002. A quality assurance system is essential in ensuring that the home is run in the best interests of the residents. It is about seeking the views of residents, relatives and visiting professionals, in order to act on these views and so improve the quality of care within the home. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 19 Staff confirmed that the deputy manager has started a programme of supervision for staff, focusing on a number of practice issues. Some aspects of how the health, safety and welfare of residents and staff are promoted were inspected. The first aid boxes in the home have now been restocked. The names of staff undertaking fire drill training are now being recorded. As mentioned previously, there is a health and safety concern that residents who are prone to wander can leave the building, without staff being aware. A statutory requirement was made with regards to this. A training matrix has been developed and a rolling programme of training in first aid, moving and handling, food hygiene, infection control and fire has been established. Two staff are moving and handling assessors and the new moving and handling assessments that they have undertaken for residents are clear and easy to use on a day-to-day basis. Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 20 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 2 X 3 2 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 2 X X 3 X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X 2 X 2 Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 21 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement The registered person must ensure that the Service User Guide contains: the name of the current registered manager; the correct category of registration; and the contact details of the local social services and health authority The registered person must ensure that the Statement of Purpose contains: the name and qualifications of the current registered manager; fee range; and should consider including the staff training programme under ‘staff qualifications The registered person must ensure the safety of residents by fitting an alarm to the fire door on the conservatory The registered person must ensure that a suitable plan of intervention is developed for all residents who present behaviour that challenges the service The registered person must ensure that the following procedures for recording the recording of the administration DS0000023590.V280451.R01.S.doc Timescale for action 03/06/06 2 OP1 4 03/06/06 3 OP38OP4 13 4 c 03/05/06 4 OP7 15 (1) 17/03/06 5 OP9 13 (2) 10/03/06 Saxon Lodge Version 5.1 Page 22 6 OP18 13 6 7 OP21 23 (2) (b) 8 OP26 13 (3) 9 OP30 18 C (i) 10 OP33 24 of medication are in place: All hand transcribed entries on the MAR sheet are signed and countersigned; a record is kept of the amount of all medicines entering the home; any medication that is discontinued is signed for and countersigned. The registered person should ensure that: - eye drops are administered as prescribed for one resident; and that ‘as required’ medication that is no longer in use is returned to the pharmacist The registered person must ensure that the adult protection policy includes procedures for dealing with physical or verbal aggression by residents and the circumstances in which to refer the matter to the local social services department The registered person must complete the tiling work in two residents ground floor ensuite bathrooms The registered person must ensure that robust laundry procedures are in place to prevent the spread of infection The registered person must ensure that new staff receive structured induction training to National Training Organisation specification The registered person must ensure establish and maintain a system for reviewing and improving the quality of care provided by the home 03/05/06 03/05/06 03/04/06 03/04/06 03/08/06 Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 23 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 OP7 Good Practice Recommendations The registered person should ensure that risk assessments are broadened to include all potential risks to residents and are further developed to include the action to be taken to minimise the potential risks to residents The registered person should ensure that all incidents are recorded on an incident form in addition to being recorded in the residents care plan 2 OP18 Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 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 Saxon Lodge DS0000023590.V280451.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!