Inspection on 05/07/06 for Saxon Lodge

This inspection was carried out on 5th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 03/02/06

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 Wendy Jones Unannounced Inspection 5th July 2006 09:30 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.V299337.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. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 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.V299337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. LD (E) is restricted to one (1) person whose date of birth is 24.07.1932 3rd February 2006 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 condition of registration that allows for one person with a learning disability. A further condition of registration is currently being processed for 3 people with dementia. An extension is also currently being built which will provide a further five rooms. The home is situated in a quiet road, in the rural village of Bridge. Local buses run through the village to Canterbury, Dover and Folkestone. The home has a statement of purpose that gives information about their service. A copy can be obtained from the home. The most recent inspection report can be seen on display in the home. Currently the scale of fees is between £381 and £540. Hairdressing, newspapers and magazines, telephone, toiletries, dry cleaning and taxis are at an additional charge. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Wendy Jones, Regulatory Inspector, carried out this key inspection. It was carried out over a period of time and concluded with a site visit to the home between 9:30am and 16:15pm on 5 July 2006. A range of evidence has been used to inform this report and judgements have been made based on this evidence. Evidence used includes, concerns, complaints, allegations and other information received, reports of incidents and deaths that have occurred in the home since the last inspection, a tour of the home, inspection of some records, comments received from care managers and residents and discussion with the manager, deputy manager, residents and staff. What the service does well: What has improved since the last inspection? The home’s statement of purpose and service user guide have been updated. They now include all the information that prospective residents need to give them an accurate picture of the service the home provides. Building work has meant that the conservatory has been demolished and so an alarm that was to be fitted to the fire door is no longer required. However, an alarm planned for the ground floor fire door leading to the road will provide a safer environment for residents. The tiling work in two en suite bathrooms on the ground floor has been completed. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 6 Residents’ care plans now contain information about what to do when the behaviour of residents is challenging. Medication procedures have been updated and medication is now administered, stored, recorded and returned appropriately. The programming of a new washing machine and updating of laundry procedures to prevent the spread of infection in the home have been completed. All new staff now follow the skills for care induction course. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective residents have all the information they require to decide whether the home is for them. Staff have the skills required to meet the specialist needs of three service users with dementia. EVIDENCE: A revised statement of purpose and service user guide were received by the Commission prior to the site visit. These had been updated as required and gave accurate information about the service currently provided by the home. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 9 Information received before the site visit confirmed that initial assessments are now undertaken prior to admission. The application to vary the home’s registration for three residents who have been diagnosed with dementia was discussed and their care plans were seen. Information provided to the Commission by the home prior to the site visit stated that five residents have dementia. The manager advised that they have identified that the needs of two of these residents can no longer be met by the home. They will be contacting their relatives, care managers etc., about moving them to a home that is more suitable for them. The manager agreed to advise Commission when this is done. The inspector will recommend that a condition to the home’s registration is agreed for three residents with dementia. Further training in dementia and challenging behaviour has taken place and the majority of staff have now received this training. Staff were confident they had the skills and knowledge they need to care for the residents with dementia. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ general health and personal care needs are met. EVIDENCE: Residents’ care plans had been developed since the last inspection. They were clearly written and easy to follow. They included a plan of intervention for challenging behaviour. However, two looked at had not been updated to include recent care plan assessments from the community psychiatric nurse. Another contained accident records that suggested that the resident had been having falls in recent months. But the monthly risk assessment stated that there had been no falls in the last year. Care plans must be kept up to date so that care staff can be sure they have all the information they need to care for the residents. Care plans are reviewed monthly and comprehensive daily records are kept. Staff had a good understanding of the care needs of residents. They also contained details of when they had seen their doctor, or district nurse and of optician, dentist etc appointments. Risk assessments are now done each month. They have been broadened and include all potential Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 11 risks and action to be taken. A number of incidents had been notified to the Commission before the site visit about aggression and violence of some residents towards others, of residents wandering outside and of agitated or aggressive behaviour. These incidents had been investigated and the residents’ care plans showed the action that had been taken and how staff are to deal with them. The front door was locked and an alarm is to be fitted on the ground floor fire door to alert staff if someone opens it. Medication record sheets had been completed accurately and medication was being stored appropriately. All care staff have responsibility for medication. However, the manager said that staff only administer medication when they have received the training. A system is in place to identify when staff need refresher training. There were no hand transcribed entries on the MAR sheet that had not been signed and countersigned. The requirements to keep a record of the amount of all medicines received in the home, sign for discontinued medication, ensure eye drops are administered as prescribed and return ‘as required’ medication to the pharmacist when no longer used have now been met. New procedures for administration, ordering and disposal of medication have been written and staff have been made aware of these. Residents commented that the staff were good and they liked them. Staff on duty at the time of the site visit clearly understood the needs of the residents and treated them with respect and courtesy. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The daily routines and activities provided meet residents’ needs and are flexible. Residents keep in contact with their family and friends. EVIDENCE: An activities co-ordinator provides activities and works on a one-to-one basis with residents every Thursday. There was a notice on the notice board letting residents know that there would be a game of bingo the next day. Information sent to the Commission before the site visit listed a range of activities that are provided for the residents including arts and crafts, quizzes, board games and trips out. Residents talked about going to Dover the day before with another resident and their relative. Others said that their relatives and friends visit them regularly. A number of people came to see residents during the site visit. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 13 Relatives said the staff were good and always made them feel welcome. A two weekly menu for May was sent to the Commission before the site visit. This showed a varied menu was being provided. However, the manager advised that she intended to update the menus shortly to included three named choices each day. She also said that they would now be able to provide a more varied menu than previously. Residents said the food was good and they had plenty. Some residents went to the dining room for their lunch and staff brought others theirs in their room. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives’ complaints are taken seriously and investigated. Staff will take the correct action to safeguard residents from abuse. EVIDENCE: Information received before the site visit stated that there had been 10 complaints received by the home. Three of these had been substantiated and seven partially substantiated. The home’s complaints file contained a log of complaints received, forms with a record of the complaint and details of the investigation carried out. Training continues to be provided for staff in the protection of vulnerable adults. Staff were clear about what to do if they suspected abuse. The manager had updated the adult protection procedure. But some further updating was recommended to make it clear that the manager would contact social services, who have the lead role, if abuse was suspected, and the process to be followed if an allegation of abuse is received about a member of staff. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 15 All incidents are now recorded on an incident form and reported to the Commission. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 16 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, 23, 24, 25 and 26 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and comfortable home with private and communal rooms that meet their needs. EVIDENCE: Work on the extension is well underway. This will provide six additional en suite rooms, a bathroom, staff room and will extend the existing lounge and dining room. It is due to be completed mid-August but is about 3 weeks behind schedule. The area has been cordoned off for residents’ safety. There is no access to it from the home. A resident commented that some the armchairs were not comfortable. Another said that they understood that new armchairs were being provided. The manager confirmed that new armchairs were being purchased. Residents Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 17 were not able to sit in the garden due to the building works. A large part of the gardens have been taken by the new extension. However, there are plans to make the remaining area into a courtyard garden with containers and garden furniture when the extension is completed. The communal areas of the home have been recently re-decorated. They were pleasant and airy despite it being a very hot day. The home was clean and hygienic and there were no unpleasant odours. There is a shaft lift for residents whose bedrooms are on the first floor. Residents’ rooms were individual to them and met their needs and tastes. They had their own personal items including photos, pictures, televisions etc. Some have en suite facilities. The tiling work needed in two ground floor en suite bathrooms had been done. There are two communal toilets on the first floor and a number of communal toilets, a shower room (which is currently not in use) and a bathroom with a bath hoist on the ground floor. The manager said that a second bathroom is planned for the first floor. An existing bedroom was turned into the laundry at the end of last year. This now has a sink, an industrial washing machine with a sluice facility and a dryer. There is a separate room where clean laundry is aired before it is returned to residents. The laundry policy has been updated to make sure that there is no cross infection between clean and foul laundry. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s recruitment procedure. They are supported by staff who have the skills to meet their needs. EVIDENCE: Fourteen care staff and four ancillary staff are employed in the home. At the time of the site visit the manager, deputy manager, two care staff, a domestic and the cook were on duty. There was clearly enough staff to meet the needs of the residents in the home at this time. The current staffing level in the home is 336 hours a week, which is higher than the 269 hours a week recommended by the residential forum. Currently six care staff have achieved an NVQ in care. This is 43 per cent. One member of staff is due to complete this qualification soon and others are due to start it. This will mean that 50 per cent of the staff team will be trained. From records seen and discussion with the manager it was clear that staff are supported to develop further and some are doing NVQ 3. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 19 Staff files contained all the information needed including CRB checks, two references and application forms. Staff are now following a structured and appropriate induction when they start work at the home. Skills for care induction packs were seen for staff most recently employed. A training matrix is kept up-to-date on a whiteboard in the manager’s office. Subjects included health and safety, first aid, food hygiene, infection control, manual handling, adult protection, fire, challenging behaviour, dementia and nutrition. Good progress has clearly been made in ensuring that all staff attend these courses and receive updates when needed. Individual training files for staff contained a list of the training they had attended, the dates and certificates. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-managed home that is run in their best interests and safeguards their rights. EVIDENCE: The manager has a number of years’ experience of managing in the care sector and has achieved the Registered Managers Award. The home was well run and management and staff were welcoming. Staff said that they enjoyed working at the home and “there is a good team” that work well together. They said that they feel well supported by management and have the skills and resources they need to do their jobs well. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 21 The manager has taken advice and is putting together a quality assurance system to get the views of residents and their families about the home. This was required at the last inspection and is to be in place by 3 August 2006. Survey forms to be used were seen and the manager stated that she intended to carry out a survey once a year. The first survey will take place when the extension is finished. Information received before the site visit stated that the home does not act as appointee for any residents. Their relatives deal with their finances. However, small amounts of money are kept for residents. Records were seen for each resident, which showed the money held, how much had been spent, on what and receipts. The balance on these sheets was checked against the money held for two residents. These tallied. Each resident’s money is kept separately and securely. Supervision records were seen in staff files. These showed that staff are observed every eight weeks. The manager explained that staff now meet with their supervisor and discuss various subjects. Records of these supervisions were also seen. Information received prior to the site visit showed that all relevant maintenance and checks have been done and are up to date. An alarm is needed on the ground floor fire door that leads out onto the street. This has been ordered. Work was due to begin on 1 July 2006 but had not started. The manager advised that this is being chased and completed as soon as possible. The manager had had some concerns about residents’ safety if there was a fire because a fire exit at the end of the building had been lost when the building works started. A meeting was held with appropriate people and an emergency walk has now been erected. Staff spoken with said that fire alarms are tested weekly and regular, unannounced, fire drills are held, usually monthly. They were clear and confident about what to do if the fire alarm sounded. Training records showed that staff have attended fire and manual handling training and are kept up to date. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12(1) and 14(2) (b) Requirement Timescale for action 05/08/06 2. OP33 24 The registered person must ensure that care plans include up to date risk assessments and assessments by other professionals so that care staff can be sure they have all the information they need to care for the residents. The registered person must 03/08/06 ensure establish and maintain a system for reviewing and improving the quality of care provided by the home This requirement is continued from the last inspection. 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 OP18.2 Good Practice Recommendations Adult protection procedures should be updated further to make it clear that the manager would contact Social DS0000023590.V299337.R01.S.doc Version 5.2 Page 24 Saxon Lodge Services, who have the lead role, if abuse was suspected, and the process to be followed if an allegation of abuse is received about a member of staff. Saxon Lodge DS0000023590.V299337.R01.S.doc Version 5.2 Page 25 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.V299337.R01.S.doc Version 5.2 Page 26 - 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!