CARE HOMES FOR OLDER PEOPLE
Seaton Lodge Residential Home 7/9 Seaton Avenue Mutley Plymouth Devon PL4 6QJ Lead Inspector
Jane Gurnell Unannounced Inspection 7th November 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 Seaton Lodge Residential Home DS0000003469.V295130.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. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Seaton Lodge Residential Home Address 7/9 Seaton Avenue Mutley Plymouth Devon PL4 6QJ 01752 667077 01752 667077 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) Mr Geoffrey Briddick Mrs Louise Catherine Evans Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Age 60yrs No more than 18 service users to be accommodated at any one time Date of last inspection 07/02/06 Brief Description of the Service: Seaton Lodge is located in the Mutley area of Plymouth. It is a medium sized care home situated in a residential area on the edge of Mutley Plain shopping precinct. The home provides accommodation and personal care for up to 18 older people from the age of 60yrs, some of who may have dementia. Accommodation is provided over 3 floors with a passenger lift and stair lifts providing access to the 1st and 2nd floor, although there are some steps linking mezzanine floors. There are 2 lounge rooms on the ground floor, one of which is made available for residents who wish to smoke. The home endeavours to create an environment to meet the individual needs of each service user. The home has a family atmosphere due to the efforts of the owner, Registered Manager and staff to ensure a non-institutional atmosphere. The Registered Manager is Mrs Louise Evans who is in charge of the day-to-day care of residents. The current weekly fees for the home range from £290 to £310. Information about the services provided at Seaton Lodge can be obtained directly from Mrs Evans. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on 7th November 2006. A 2nd announced visit was made to the home on 9th November to examine staff personnel files that were not accessible on the first day due to the Registered Manager not being on duty at the time. Prior to the inspection, the Commission sent surveys to each resident and their relatives to allow them to comment directly to the Commission. Five were returned from residents and three from relatives: all were positive in their comments about the quality of service provided at Seaton Lodge. The inspector made a tour of the building, spoke with 12 residents and the staff on duty, and reviewed the care plans of 4 residents in detail as well as 2 staff personnel files. What the service does well: What has improved since the last inspection?
Mr Briddick continues to invest in the home to improve the environment for the benefit of the residents: all those bedrooms that have sufficient space have been fitted with an en suite toilet. Stairs lifts have been fitted to one set of stairs and the passenger lift has been renewed allowing access to the 1st and 2nd floors from both sides of the home. Since the previous inspection, Seaton Lodge has been registered with the Commission to provide services to older people with dementia and as such all the care staff have either completed or are currently undertaking a certificated, distance learning training course in the care of people with dementia. This training will ensure the staff have the knowledge to understand the condition of dementia and the principles of good quality care. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Seaton Lodge Residential Home DS0000003469.V295130.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 Seaton Lodge Residential Home DS0000003469.V295130.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process ensures that residents can be confident that care staff are aware of their needs prior to their admission and are able to meet those needs. EVIDENCE: Seaton Lodge is a small home and as such vacancies do not arise frequently. Mrs Evans, however has a pre-admission assessment procedure: she confirmed that she visits each prospective resident to assess their needs to ensure Seaton Lodge is a suitable home and that staff have the skills to support the resident. One newly admitted resident confirmed that Mrs Evans had visited him in hospital and informed him about the services provided at the home. He said that he has settled in very well and finds all of the staff very friendly. Prospective residents may visit the home and spend time with the staff and other residents before making a decision to move in. All senior staff have completed their training in the care of people with dementia and are supporting the remainder of the staff through their training, ensuring each has the necessary knowledge to provide good quality care to people with dementia.
Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 9 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are being met and residents are treated respectfully. EVIDENCE: Residents described living at Seaton Lodge as “lovely” and “very nice” and said that they were very well cared for. The 5 surveys received prior to the inspection also confirmed this; one resident said “everyone is always very nice to me”. The inspector observed the owner, Registered Manager and staff interacting with the residents in a very friendly and respectful manner: both staff and residents appeared happy and jovial. Those care plans sampled provided a brief, but clear description of the residents’ care needs and the action required by staff to meet those needs A summary of care needs was drawn up from an assessment of activities of daily living which provided an indication of the level of support required by each resident. Mrs Evans was advised to include a more detailed description of how a resident’s dementia affects their daily living abilities and the information
Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 10 staff need to support each resident in a consistent manner. Promoting and supporting residents with dementia to maintain their independence is important and unless all the staff are aware of a resident’s abilities there is a risk that a resident could become unnecessarily dependant upon staff. It is also important to know how a resident’s confusion affects them and whether this causes anxiety or distress. The Registered Manager had reviewed care plans monthly and any amendments were clearly identified. Evidence was available that the Registered Manager sought advise from other health care professionals such as the District Nurse and the Continence Advisor to ensure the care needs of the residents are fully met. Medication was stored safely: there were no controlled drugs held in the home at the time of the inspection, however safe storage was available should there be any prescribed in the future. The medication records were examined and were found to be accurate. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they will be encouraged to make choices about their lifestyle at Seaton Lodge. Meals are nutritious and varied. EVIDENCE: Residents said that the routines of the home were flexible and they were free to come and go as they pleased. The social and leisure activities in the home include games and bingo, reading and music. Residents spoke fondly of the outings that are organised fortnightly by Mr Briddick, the owner, when he takes residents out for a pub lunch and trips to local beauty spots and places of interest. Those relatives that returned a survey said they were made welcome and could visit their relative in private. Residents said that the food was plentiful and very good, and that drinks and snacks were available at all times. Alternatives to the menu are available upon request. One relative said that her father had a poor appetite and “Mr Briddick purchased speciality food to tempt him”. This relative goes on to say that her father has received care services for 16 years and “he has been happiest and most at home in Seaton Lodge”. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 12 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and suggestions from residents, relatives or other visitors to the home, are treated seriously. Residents are listened to and issues resolved promptly. EVIDENCE: Residents said that the owner, Registered Manager and the care staff are very approachable and they were confident that any issues of concern would be dealt with promptly. Neither the Commission nor the home have received any complaints since the last inspection. One of the 3 relatives that responded using the Commission’s survey felt the communication between herself and the home could be improved: this was passed to Mrs Evans who said that she would ensure all relatives are kept up to date with events should that be the wish of the resident. Mrs Evans has completed a training course in the protection of vulnerable adults and is making training available to the remainder of the staff ensuring they have the knowledge to recognise abuse and the actions to take should they suspect that a resident has suffered abuse. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 13 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, 20, 21, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Seaton Lodge is a warm and comfortable home. The unguarded radiators place residents at risk of injury. EVIDENCE: Residents said they found the home comfortable, clean and warm. They said their bedrooms are spacious and they were pleased with the new toilet facilities: all bedrooms with sufficient space have been fitted with an en suite toilet. The enlargement of the ground floor toilet by the lounge and dining rooms has made access easier for those residents who use a walking frame or a wheelchair. The home was found to be clean, tidy and free from offensive odours. The temperature of the hot water in baths and some wash hand basins identified as posing a risk of scalds to the residents has been controlled: advise was given to control the temperature of all hot water accessible by residents,
Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 14 particularly in light of the new registration category to admit residents with dementia, who may be more at risk from scalds. Radiators are uncovered: although none of the current residents have been identified as at risk from burns Mr Briddick gave assurances that all radiators would be covered within the near future. Many of the bedroom doors had been fitted with locks of a type that provided privacy for residents in their rooms but not security as they did not require a key to be unlocked. The laundry room floor requires re-sealing to prevent any soiled materials from soaking into the concrete and to make it more easily cleaned, reducing the risk of cross infection. The outside patio area had been tidied since the last inspection, a table, chairs and umbrella had been purchased and a mural has been painted on the wall making this a pleasant space for residents to use, many of who said they enjoyed using the patio during the summer. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by trained and motivated staff in sufficient numbers to meet the needs of those currently living in the home. Recruitment practices protect vulnerable residents. EVIDENCE: Residents described the staff as very kind and caring and confirmed they responded promptly to requests for assistance indicating that there are sufficient staff on duty to meet the needs of those currently living in the home. At the time of the inspection there were 3 care staff on duty as well as the owner, a domestic, a cook and maintenance staff. The duty rota indicated that when Mrs Evans, the Registered Manager is on duty this does not affect the number of care staff available. The majority of staff have gained a National Vocational Qualification (NVQ) in Care for which they were required to demonstrate through their work performance their knowledge and skills in caring for older people. All staff are currently undertaking training in the care of people with dementia and those on duty were able to describe their understanding of the needs of people suffering from confusion and anxiety. The files of two newly appointed members of staff contained the required documentation ensuring as far as possible only suitable staff are employed at the home. Induction programmes are provided for new staff to introduce them to care principles prior to them registering for NVQ training.
Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents benefit from a relaxed and approachable management style. Quality assurance processes could be improved to ensure staff, residents and relatives have the opportunity to formally comment upon the quality of the services provided at Seaton Lodge. EVIDENCE: Mrs Evans and Mr Briddick are in day-to-day charge of the home. Mrs Evans is the Registered Manager and has been at Seaton Lodge for eight years. She is a Level 2 Registered Nurse and holds the NVQ4 in Management certificate. Both she and Mr Briddick promote a friendly amiable atmosphere in the home and residents spoke well of them both, confirming that they are available to deal with any issue that may arise.
Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 17 Records provided evidence that staff have received training in first aid, manual handling and fire safety training ensuring they have the knowledge and skills to deal with emergencies. Money is held for safekeeping for 5 residents: individual records are maintained. Two balances were randomly checked by the inspector and were found to be correct. Mrs Evans said that she consults with residents and staff each day about their satisfaction with the home, but she does not record this unless there is a concern raised. Advise was given to expand this consultation to include a more formal Quality Assurance process thereby ensuring staff, residents and relatives are able to contribute to the quality of the service provided and allow Mrs Evans to provide evidence of her and Mr Briddick’s commitment to the continual improvement of the service. Mrs Evans has recently completed a training course in ant-discriminatory practices and the promotion of equality and diversity, and confirmed that the home was in a position to meet the needs of residents from different faiths and cultures. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 18 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 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 X 3 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 3 Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 19 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 OP25 Regulation Reg. 13(4)(a) Requirement Timescale for action 31/03/07 2. OP26 Reg. 13(3) 3. OP33 Reg. 24 The registered person shall ensure that (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (All radiators in rooms accessible to service users must be covered or have a guaranteed low temperature surface to protect them from the risk of burns). The previous timescale of 31/08/06 has not been met. The registered person shall make 31/12/06 suitable arrangements to prevent infection, toxic conditions, and the spread of infection at the care home. (The laundry room floor must be sealed). The previous timescales of 31/12/05 and 01/03/06 have not been met. (1) The registered person shall 31/03/07 establish and maintain a system for - (a) reviewing at appropriate intervals; and(b) improving, the quality of care provided at the care home, including the quality of nursing where nursing is
DS0000003469.V295130.R01.S.doc Version 5.2 Seaton Lodge Residential Home Page 20 provided at the care home. (2) The registered person shall supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy of the report available to service users. (3) The system referred to in paragraph (1) shall provide for consultation with service users and their representatives. (The Registered Provider must introduce a quality assurance and quality monitoring system). The previous timescale of 01/06/06 has not been met. 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 OP25 OP24 Good Practice Recommendations The Registered Provider should give consideration to controlling the temperature of all hot water accessible by residents to protect them from the risk of scalds. The Registered Provider should give consideration to providing bedroom door locks that provide security as well as privacy and that can be overridden by care staff in an emergency. Seaton Lodge Residential Home DS0000003469.V295130.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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