Inspection on 11/08/06 for Squirrel Lodge Residential Home

This inspection was carried out on 11th August 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

Squirrel Lodge Residential Home 13/08/07

Squirrel Lodge Residential Home 21/02/06

Squirrel Lodge Residential Home 28/09/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Squirrel Lodge Residential Home 541 London Road South Lowestoft Suffolk NR33 0PD Lead Inspector John Goodship Key Unannounced Inspection 11th August 2006 10:00 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 DS0000064004.V307642.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. DS0000064004.V307642.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Squirrel Lodge Residential Home Address 541 London Road South Lowestoft Suffolk NR33 0PD 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) 01502 515423 Squirrel Lodge Ltd Mrs P M Hunton Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places DS0000064004.V307642.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st February 2006 Brief Description of the Service: Squirrel Lodge started as a small home for the three older people in 1984. It was first registered in 1987 and has been adapted and extended over the years and now provides residential care for up to twenty-two older people. It is set back off the main road into Lowestoft and is close to community facilities including local shops, the promenade and the beach. The home has private gardens with level pathways and the majority of rooms have patio doors opening to the well-maintained external areas. The home has a gravelled car parking area to front. At the time of inspection, the fees ranged from £339.00 to £362.50 per week. DS0000064004.V307642.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection under the Commission for Social Care Inspection policy “Inspecting for Better Lives”. It was classified as a key unannounced inspection, and was intended to cover all the key standards which are listed overleaf under each outcome group. The visit lasted for 6.75 hours starting at 09:45. The registered manager, Mrs Hunton, was present throughout, with Mr Hunton and the deputy manager present for part of the visit. The inspector toured the home, speaking to five residents either in their rooms or in one of the sitting rooms. Records of two care plans, and two staff files were examined. In addition, residents and relatives were invited to complete a survey beforehand. Twelve residents and twelve relatives responded, and their comments have been included in the report. What the service does well: What has improved since the last inspection? What they could do better: DS0000064004.V307642.R01.S.doc Version 5.2 Page 6 The home must put into place a formal programme of one-to-one staff supervision to ensure that staff training needs and concerns about their work are identified and action taken where appropriate. The manager must obtain the consent of residents or their representatives to any form of restraint, such as bedrails. 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. DS0000064004.V307642.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 DS0000064004.V307642.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): 1,2,3,5 Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can expect the home to provide accurate information about the services it offers, and to give them a chance to visit the home. EVIDENCE: The form of contract was seen, together with the separate letter which was issued at the same time advising of fees. All resident who responded to the pre-inspection survey confirmed that they had received the contract. There was no information in either the contracts or the Service Users Guide about how any increases in fees would be applied and implemented. This is a recommendation from the Office of Fair Trading report on care homes. All residents who were spoken to said that they had received enough information to make a decision on the home. One said: “I waited 6 months in Hospital for a place here because of all the good reports.” Another said that: “I came as a day visitor before deciding.” DS0000064004.V307642.R01.S.doc Version 5.2 Page 9 The manager stated that when a single room became vacant, existing residents in shared rooms were offered first refusal before people on the waiting list were offered it. One resident said that they had been so keen to come into the home that they had taken a vacancy in a shared room to ensure that they would be able to move into a single room later. A pre-assessment form was available that incorporated all the elements required by Standard 3 of the National Minimum Standards. These identified the needs of the potential resident. Copies were seen in their files. DS0000064004.V307642.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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and care needs are identified and monitored to ensure that they are met. Residents are safeguarded by the revised procedures for the administration of medication. Residents can be assured that they will be treated with respect and dignity, including at the end of life. This respect will be evidenced further enhanced with proper consent procedures. EVIDENCE: A sample of care plans was examined. They were in two separate parts, one containing a copy of the contract, the pre-admission assessment and an inventory of possessions brought into the home. The second was a working file containing the daily report, care needs, and risk assessments. One file contained the risk assessment for a resident who was self-medicating. It was not clear how frequently this assessment was reviewed to ensure that the resident continued to have the competence to self-medicate. There was evidence that care plans were regularly reviewed, and identified care needs and how they should be met. Night care needs had been recorded following the previous inspection. Staff who were spoken to demonstrated that DS0000064004.V307642.R01.S.doc Version 5.2 Page 11 they were aware of residents’ needs. Residents surveyed all said that they always or usually received the care and support they needed. Drinks were observed to be available and within reach in the communal areas as well as individual rooms. One resident needed to be given fluids through a syringe into their mouth. This was documented in their care plan, although consent to this procedure was not recorded. Since the inspection, such consent has been obtained and a copy sent to the Commission. Following the previous inspection, the home had installed a new medication trolley for improved security, and had revised their medication policy to satisfy the good practice guidance of the Royal Pharmaceutical Society. Staff felt medication rounds took longer but accepted the necessity for safety and security. The temperature of the drug fridge was recorded and was within the safe range on the day. On examining the MAR sheets, it was noted that there were gaps in signatures for two residents on the same shift. The manager investigated at once with the member of staff responsible who was on duty. The omissions were able to be corrected. It was stated that the home intended to put photos of residents on the MAR sheets for extra certainty of identification. A relative commented that “the staff and owners are always very cheerful and caring and treat everyone in the home with respect and consideration. I cannot speak too highly of them.” The manager described the care of a recently deceased resident. The home had been well-supported by the GP and district nurse. The district nurse had supplied a special airwave mattress. The home had installed an overhead hoist, which could be moved from room to room relatively easily. This improved safety for the carers, and was more dignified for the resident. It also removed the need to store and manoeuvre a floor hoist. The manager described the help given to a resident of a particular faith who wished to be buried in their own faith cemetery. Eventually the home had located one in Norwich and their wishes could be followed. DS0000064004.V307642.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be assured that they will be supported to continue their interests and social contacts when they come to live in the home. Residents have choice over the pattern and content of their daily lives. Their nutritional needs will be met according to their wishes. EVIDENCE: The inspector spoke to 3 residents who were in the front sitting room with others. They said that they preferred to sit in that area as they could see everyone going in and out of the home. One said it was a very good home. Residents had opportunities to go out if they wished. One went out to social events although well into their nineties. One person said they hoped to invite some friends in to play bridge. The manager confirmed that this was planned. Other people went to social groups, and outings were organised by the Library Service. One resident’s room had their name in large letters on the door and on the toilet door. This was an aid to them as they were losing their sight. DS0000064004.V307642.R01.S.doc Version 5.2 Page 13 One resident said how happy they were in the home and how “nice my room is”. They had a telephone with extra large numbers and used it often. There was a large patio door into the garden but they said they did not use it as there was a step down. They could get to the garden by another exit. The garden was well kept with colourful flowers, which the resident commented on. A carer delivered the daily papers while the inspector was in the room. There was a cabinet full of ornaments. “I’ve really got too many” they said. They said that they always chose to have breakfast in their room. One resident was sitting in the front communal area in a wheelchair/armchair, which allowed them comfort while sitting for long periods in the lounge, but could be easily moved by staff without the need to be transferred by hoist. This person’s room had been fitted with an overhead hoist. Bedrails were fitted but there was no evidence of consent to these in the care plan by the resident or their relatives. Evidence was received subsequent to the inspection visit to show that action had been taken to seek and record consents. One resident commented that the food had deteriorated with not such good ingredients. This comment was not supported by the comments of other residents, nor from the observation at lunch time. The menu which was written on a board in the dining room consisted of pork slices with potatoes and fresh vegetables which was well presented and which everyone seemed to enjoy. Alternatives were available. All residents had put in their survey forms that the food was always or usually to their liking. A relative said that “ meals were well presented, and tea and coffee were available when I visited in their room.” A visitor commented that everyone is made welcome by caring staff. “Squirrel Lodge is a pleasure to visit. Any questions we have are dealt with immediately. Family and friends are made to feel part of the Squirrel Lodge family rather than visitors.” Housekeeping was of a high standard and there were no unpleasant smells. Rooms were cleaned daily but were spring cleaned thoroughly once a fortnight. One room was seen to be undergoing its spring clean during the inspection. If the resident needed to vacate their room temporarily while this was happening, they were helped to the nearest sitting room. DS0000064004.V307642.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns and complaints would be dealt with properly and quickly. They are safeguarded by the staff’s training and procedures against abuse. EVIDENCE: The home had a complaints procedure which contained all required details for the information of residents and visitors. All residents said that they knew how to make a complaint, and would feel able to do so. One said that if they mentioned anything to staff, it would be dealt with straight away. The complaints log was seen but no complaints had been received. The home had a copy of the local adult protection protocol, and senior staff were aware of the correct procedures to follow. The deputy manager had completed a refresher course in adult protection and the manager was waiting to attend. The record of other care staff showed that all were up-to-date with adult protection training. A member of staff was able to explain some kinds of abuse, and say what action they would take if it occurred. DS0000064004.V307642.R01.S.doc Version 5.2 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): 19,20,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and clean. Its design gives all rooms a garden view. Residents can be assured that their rooms can be personalized, and homely. Specialist equipment will enable them to be cared for appropriately and safely. EVIDENCE: During the visit the home was very clean and tidy. There were no unpleasant odours and residents talked positively about the “high standards” the home expects. All responders had stated in the pre-inspection survey that the home was always fresh and clean. One resident said they enjoyed tending the garden in front of their bedroom. The garden was very well kept and residents said they enjoyed looking out on the flowers and going out in warm weather. Residents confirmed that they chose whether or not to bring their own furniture into the home or not. Rooms were individual and residents talked DS0000064004.V307642.R01.S.doc Version 5.2 Page 16 happily about the pictures they had on their walls, their ornaments, and the view from the window. The dining room was comfortably furnished with dark wood tables and chairs. The chairs had cushions on them and the room was carpeted. These made the room pleasant and gave a quiet and homely atmosphere. It was large enough to seat all residents. There was an area off the main lobby where wheelchairs were stored in an unused entranceway to keep them nearby for use but not obtrusive. The home had two moveable overhead hoists. These gave the flexibility to respond to the needs of residents as their needs changed. “Dorguards”, which held the doors open until the fire alarm sounded, were fitted to the bottom of three bedroom doors in the older part of the home. This allowed those residents the choice of keeping their doors open or closed. Newer doors were linked electronically to the fire alarm. Cleaners were observed doing a fortnightly spring clean in one room. The manager stated that all rooms were subject to this level of cleaning once a fortnight. There was a sitting room at the rear of the home, where a resident could sit while their room was being cleaned if necessary. The manager stated that this room, although comfortably furnished with a view over the rear garden, was only usually used by one or two residents. It was empty when visited. One hot water outlet was tested and showed a temperature of 43°C. DS0000064004.V307642.R01.S.doc Version 5.2 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents will be cared for by sufficient, trained, and competent staff who have been recruited safely. EVIDENCE: There were no staff vacancies at the time of inspection. There were two staff away on long-term sick leave but their absences were being covered by staff doing extra shifts. Two personal files were examined for staff recently appointed. Both files contained all the required identification and reference documentation. Both had started before receipt of the full CRB disclosure certificate, but POVA list returns had been received before their start dates. Eight out of ten care staff (including the Deputy Manager) have achieved NVQ2 or above exceeding the workforce training target of 50 . In addition, four staff were studying for Level 2, and two for Level 3. The home only allows senior carers to handle medication, all of whom have attended courses for this. The manager and the deputy were waiting for the pharmacy supplier to put on an Advanced Medication course so that they could update their practice. A relative commented that “the staff are very professional and yet caring, friendly and approachable.” DS0000064004.V307642.R01.S.doc Version 5.2 Page 18 There were three staff certificated as moving and handling trainers, who undertook the training and updating of all staff. The manager stated that she was planning to produce a training spreadsheet and a record of each individual’s training for their records, to improve the planning and recording of training. Staff rosters were examined which showed that there were sufficient staff planned to be on each shift to meet the needs of the current residents. The rosters contained full information to show who had actually been on duty on each shift. DS0000064004.V307642.R01.S.doc Version 5.2 Page 19 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): 31,32,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to feel that they are at home as far as possible, with the owners and carers as friends. Residents benefit from the friendly, open and positive attitudes of the owners and staff. They can be assured that the home is run in their best interests. A formal system of recorded staff supervision will maintain and improve the competence and the caring skills of staff. EVIDENCE: Residents commented about how the home was run. They felt able to approach and discuss things with the home’s owners who were usually there everyday. Residents talked about the owners and it was clear that they have a good relationship with them. One resident said that the home was “like having an extended family”. A relative said that it was “a wonderful home the residents DS0000064004.V307642.R01.S.doc Version 5.2 Page 20 can truly call “their home”. Everyone is made welcome by caring staff. Squirrel Lodge is a pleasure to visit.” An Administrator had joined the team at Squirrel Lodge last year. The impact was seen in the well-organised policies and records.. The Deputy Manager said this had had a positive impact on their workload and had “freed them” to work on other aspects of the running of the home. The current process of quality assurance, as stated by the manager, was by observation of care practices by senior staff, and by listening to staff and residents. The survey of residents demonstrated that all of them reported that staff did listen to them. The home had employed a part-time handyman to ensure a rapid response to the need for repairs. The manager was also hoping to implement a quality assurance system that would cover an annual audit of care plans, resident surveys, staff employment, and health and safety. A relative commented that “I think the home has a lovely atmosphere and very caring staff.” A sample of maintenance and servicing records were examined. All were upto-date. The manager showed a file of alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA), identifying equipment which had been found faulty nationally. The file recorded action taken if the home had been using the described product. The local Fire Safety Officer had visited the home in June and made two comments: one regarding the upgrading of bedroom doors to meet FD30S, and the other regarding the frequency of practice fire drills. Both of these matters were being attended to at the time of inspection. The Fire Officer had given a timescale of six months. There was no recorded system of regular supervision of care staff. Each resident had lockable storage in their rooms to keep any valuables. The home looks after small amounts of money for some residents, which are locked securely in the office. When checked at the last inspection, the amount matched the records seen. Since then, staff had been required to sign money receipts and withdrawals. DS0000064004.V307642.R01.S.doc Version 5.2 Page 21 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 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 X 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 1 X 3 DS0000064004.V307642.R01.S.doc Version 5.2 Page 22 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 OP10 Regulation 12(4)(a) Requirement The registered person must ensure that written consent from the appropriate person to any restriction of movement of a resident is obtained at the point when the need is identified. The registered person must implement a formal recorded system of staff supervision. Timescale for action 30/08/06 2. OP36 18(2) 30/08/06 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 OP9 Good Practice Recommendations Risk assessment of residents who are deemed competent to administer some or all of their medication should be reviewed regularly. DS0000064004.V307642.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000064004.V307642.R01.S.doc Version 5.2 Page 24 - 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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