Inspection on 21/02/06 for Squirrel Lodge Residential Home

This inspection was carried out on 21st 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

Squirrel Lodge Residential Home 13/08/07

Squirrel Lodge Residential Home 11/08/06

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 Jo Govett Unannounced Inspection 21st February 2006 11:45 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 Squirrel Lodge Residential Home DS0000064004.V284705.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. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 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 Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th September 2005 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. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 21 February 2006 and was unannounced. The owners Mr and Mrs Hunton (also the Registered Manager) were available for part of the inspection and discussed previous requirements and developments at the home. The Deputy Manager and Senior Carer on duty were very helpful talking through the policies and procedures of the home and how it provides care. We assessed the progress of previous requirements, and completed inspecting the Key Standards. It is therefore recommended that any reader of this report should also see the previous report of the inspection completed on the 28 September 2005. What the service does well: What has improved since the last inspection? What they could do better: The medication policy and procedure needs to be reviewed to ensure that residents are not put at risk from unsafe practices. Although the home states that “Care Comes First” it must be able to evidence that staff have time to meet the care needs (including social needs) of residents. If the ability to do this is effected by financial restrictions, management planning will need to encourage innovation, creativity and development of the homes current systems. Squirrel Lodge Residential Home DS0000064004.V284705.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. Squirrel Lodge Residential Home DS0000064004.V284705.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 Squirrel Lodge Residential Home DS0000064004.V284705.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): These standards were not inspected at this inspection. EVIDENCE: Not applicable Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The home continues to place the needs of residents very highly. However some practices and procedures are unsafe and may put residents and staff in a potentially vulnerable position. EVIDENCE: The previous inspection required the home to reconsider the way it keeps the supplementary information regarding residents’ care. Daily Personal Care Schedules are kept in resident’s bedrooms and the schedule is “ticked off” by carers as the tasks are completed. In shared rooms this information has been removed from general display and placed in individuals wardrobes. Those in single rooms still have this information out. No agreements are in place with residents about whether they mind this approach or have agreed it. The home said that a policy and procedure states that confidential information is kept securely and locked away. They went on to say that the schedules are a prompt for carers to remind them of what care is needed, enabling them to get on with the care, rather than having to read the care plan kept in the office. Care planning is being further developed and the home was able share progress on a night care plan, although this had yet to be implemented. Some information is minimal and does not consider all possible care needs or related Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 10 risks. For example a risk assessment for someone who self medicates gave information on a resident’s medication needing to be kept securely in their bedroom. Staff said that they regularly checked to make sure it has been taken and the resident only had a week’s medication at a time. This information was not documented. Medication is kept in a metal lockable cupboard and there is a medication fridge (temperature checked daily). A pharmacy provides blister packs for prescribed medication. Creams and “as required” medication are kept separately within the metal cupboard. We talked with staff about the procedure for administering medication. Senior staff only prepare medication prior to their administration by putting tablets into named pots (with lids) from the blister pack. The same member of staff then gives them out from a tray. On the day of inspection a senior carer was observed distributing the pots to residents and then returning to the office to sign the Medication Administration Records. In some cases they had not observed the medication being taken. It was fed back to the Deputy Manager and Senior Carer that these practices were unsafe and could pose a risk to residents and staff. We discussed ways the home could improve its procedures. Their main concern was around the increase in time a medication round would take if they stopped “potting up” and sign the MAR sheet following each administration. After consideration they said this may take one and a half hours as opposed to three quarters. Although a training record was provided that confirmed senior staff had had recent training in handling medication, there was no information on whether the Registered Manager or Deputy Manager had undertaken relevant training in this area. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 15 Residents benefit from the home’s willingness to review practices and see where improvements can be made. Resident choice, although reflected in some staff practice is let down by a lack of information and documentation accessible to residents. EVIDENCE: Residents said that their friends and family visited them regularly. They said that they could meet in the communal areas or take them to their own rooms within the home. A menu is available in the dining room for residents to look at. When asked, a group of residents sitting in the front lounge said they did not know what was for dinner, but one said that the menu was in the dining room. The menu does not list the alternatives available but does say that they can ask for something different. One resident was observed to ask for a yogurt instead of the pudding on offer, and a carer provided it for them. It was not clear how less able or confident residents could make a choice, although management felt that residents do know that they can ask for different things. When asked if they could make they could ask for things, a resident said “more or less, usually keep to what they suggest”. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 12 Two residents said that they had been asked if they wanted to join in with a game of Bingo, but said they preferred to stay in their rooms. Following the previous inspection the home has looked at developing the social and activity based programmes for residents. A review was carried out on the 13th of January 2006, which documents the current “in house” activities, visiting services and outings, and includes a further section entitled “Forward Thinking”. This gives information about actions the home will be considering, including, how people are informed about events and activities, a resident questionnaire and raising money for the “Residents Fund”. A further review is planned for the end of March 2006, and developments in this area will be reassessed at the next inspection. Squirrel Lodge Residential Home DS0000064004.V284705.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, 18 Residents benefit from an open approach by the home in dealing with concerns and compliments. This is let down by policies and procedures which need updating to ensure that residents, staff and other interested parties understand the homes responsibilities around protection and complaints. EVIDENCE: The home has a complaints procedure that has all the elements required by regulation. A policy is also in place, although it does not give information on the opportunity to complain anonymously or what constitutes a complaint. A log book is available in the main entrance which has letters and cards that compliment the home and it’s staff. No complaints were logged although the Deputy Manager said that one had been made, but had been resolved. The home also has a policy and procedure around abuse. The Deputy Manager stated that they were aware it needed to be updated, since the introduction of the Protection of Vulnerable Adults (POVA) list on 2004 and general good practice around recruitment. The home did not have a copy of the Local Area Protection Committee Protocols on POVA. An immediate requirement to obtain them was made, which the Deputy Manager acted on during the inspection. The Deputy confirmed that issues of abuse are covered in induction and NVQ training, but they and the Registered Manager have not had recent POVA training updates or the implementation of local procedures. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 14 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 Residents benefit from the home continuing to have a very homely atmosphere. EVIDENCE: On the day of inspection the home was clean and tidy. Residents commented that they liked looking out of their windows at the garden and the flowers that are starting to come out. The home appeared well maintained and residents said that they were “very comfortable”. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The home recognises the importance of training and its benefits. Residents cannot be assured that the current numbers of staff will have time to adequately meet ongoing care needs. EVIDENCE: The Registered Manager and Deputy have undertaken a course to provide moving and handling training for staff at Squirrel Lodge. The Deputy Manager said that this had been beneficial and they had updated their practice, even though the current residents do not need some techniques. Records of meetings held by management regarding the progress of training at the home were given to the inspector. Eight out of ten care staff (including the Deputy Manager) have achieved NVQ2 or above exceeding the workforce training target of 50 . The home only allows senior carers to handle medication, all of whom have attended courses for this. There is no date listed for the Registered Manager or Deputy for Medication or Food Hygiene training. The home does not have a dedicated activities co-ordinator. However the home acknowledges that interaction with staff is important and that residents sometimes just like staff “sitting and talking”. They acknowledge in their review of activities that there is “not always time for this” so they plan to make efforts to sit with residents during lunch. Staff also expressed concern about the amount of additional time changes to the current medication procedure might bring. The Deputy Manager and a Senior Carer said that their time in Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 16 direct contact with residents was becoming less and less, as administration work was becoming more demanding. On the day of the inspection there were enough staff on duty to attend to the residents requests when made. Evidence gathered at the last inspection showed that the recruitment policy and procedure needed updating as it has guidance about employing before a written reference is received. Two staff files were seen and included the required elements. The standard outcome was not scored on the previous report and therefore has been included in this report. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 17 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, 35, 37, 38 Residents and their representatives benefit from the homes open and positive atmosphere. This is let down by conflicting information about how staff meet all the daily needs (including social interaction), given the levels of staffing and a lack daily record keeping. EVIDENCE: The homes management is run very much as a team. Mr and Mrs Hunton as the owners and Registered Manager along with the Deputy are in day to day control of the home. Staff said that they usually approached the Deputy Manager first as they are there generally on duty Monday to Friday, but they also know the owners very well and discuss issues with them regularly. While the home is running well Mrs Hunton, as the Registered Manager has not yet undertaken a relevant qualification (e.g. NVQ 4 Management and Care) as described in the National Minimum Standards for Residential Care Homes. The Deputy Manager has completed the NVQ 4 Combination Award. All the Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 18 members of the management team live locally and commented that they can be at the home within a matter of minutes if needed. The home has reviewed their working practices in an action plan submitted following the last inspection. This concluded that combining care and domestic activity “is in the best interest of all concerned and should not be changed. All staff are instructed and understand the ‘Care Comes First’”. It then goes on to say that; “Varying work load situations should not be confused with what is best policy for Squirrel Lodge and when staff are severely stretched and at the same time working correctly then it is our responsibility to provide adequate resources within financial constraints, bearing in mind Standard 34 i.e., the financial viability of the home to safeguard residents safe tenancy.” Other records at the home are not fully up to date. For example care plan daily records do not have entries everyday. A diary is kept of activities/outings residents partake in, but this is communal and does not reflect how their individual assessed need in this area is met by the activity undertaken. Some poor practice was observed with the medication procedure, including the completion of multiple Medication Administration Records after medication had been distributed in named pots. The Deputy Manager was keen to ensure the shortfalls in this areas are rectified, and confirmed that they will consult with the owners about suitable changes. Each resident has lockable storage in their bedrooms to keep any valuables. The home looks after small amounts of money for some residents, which are locked securely in the office. When checked the amount matched the records seen, although staff do not sign it. Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 19 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X 2 2 Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 20 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 OP7OP8 Regulation 14 Requirement The home must ensure that care plans clearly reflect the identified needs of the resident and include instructions (and related risk assessments), on how needs are to be met. This is a repeat requirement from the inspection 28/09/05. The ‘potting up’ medication in advance of administration is unsafe and is classified as secondary dispensing. Medication must be administered from the original container at the time of administration. Medication must be transported around the home securely as detailed in Royal Pharmaceutical Guidelines MAR sheets must be completed individually following administration of medication. The practice of signing for multiple residents following medication administration must stop. The home must ensure that care DS0000064004.V284705.R01.S.doc Timescale for action 31/05/06 2 OP9OP38 13(2) 13(4)(c ) 31/03/06 3 OP9OP38 13(2) 31/03/06 4 OP9OP38 12, 13 21/02/06 5 OP10OP37 12(4)(a) 31/03/06 Page 21 Squirrel Lodge Residential Home Version 5.1 planning and other confidential information about the resident is kept securely and does not compromise their confidentiality. This is a repeat requirement from the inspection 28/09/05. 12, 13 The home must obtain the local area protection committee protocols on the protection of vulnerable adults. This must inform the homes abuse policy and procedure. 22 If the home investigates a complaint under its complaints procedure a record must be kept along with details of any actions taken. 13(6) The Registered Manager and Deputy must update their POVA training and responsibilities in line with local area guidence. 18(1)(a) The home must be able to evidence that there are suitable numbers of care staff working appropriate to the health and welfare of residents on an ongoing basis. 12, 13, 19 The home must update its recruitment policy and proceedure, taking into account the POVA guidence. 9(2)(b)(i) The Registered Manager must evidence that they have relevant training and qualifications. 17 When handling residents money and recording the amount and date of withdrawl, staff must sign the record. 17 Adequate records must be made and kept that reflect residents lives at the home. 6 OP18OP38 21/02/06 7 OP16 31/05/06 8 OP18OP30 31/05/06 9 OP27OP33 31/05/06 10 OP18OP29 31/05/06 11 12 OP31 OP37 31/05/06 31/05/06 13 OP37 31/05/06 Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 Page 22 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 OP8OP7 Good Practice Recommendations The home should introduce information onto care plans about residents night-time needs. This is a repeat recommendation from the inspection 28/09/05 The home should acquire a suitable medication trolley that complies with Royal Pharmaceutical guidelines. The home should have photographs of residents alongside their MAR sheet for identification. Menus should include information on at least two options for breakfast, dinner, tea and supper. Any standard alternatives should also be listed. The home should give a definition of what it considers a complaint to be and arrangements for making anonymous complaints. The home should be able to evidence that only people who are up to date with food hygiene training handle/prepare food for residents. The home should keep daily records that reflect the care provided to each resident. 2 3 4 5 6 7 OP9OP38 OP9 OP15 OP16 OP15 OP37 Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 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 Squirrel Lodge Residential Home DS0000064004.V284705.R01.S.doc Version 5.1 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. 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