Inspection on 28/09/05 for Squirrel Lodge Residential Home

This inspection was carried out on 28th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Squirrel Lodge Residential Home 13/08/07

Squirrel Lodge Residential Home 11/08/06

Squirrel Lodge Residential Home 21/02/06

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 28th September 2005 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 Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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.V254972.R01.S.doc Version 5.0 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 562326 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.V254972.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27 January 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 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.V254972.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken on the 28th September 2005 and was unannounced. The owners Mr and Mrs Hunton (also the Registered Manager) were away on holiday, however the Deputy Manager, Joy Sterseck, provided information and discussed issues that arose. Since the last inspection the owners have successfully changed their registration with the CSCI to reflect that they now operate the home as part of a limited company. No changes have been made to the running of the home and the owners are clear that the decision to change its status is based on securing its future. We were able to look at documentation and records and we had the opportunity to speak with residents and a group of carers. What the service does well: What has improved since the last inspection? What they could do better: Some improvements are needed so that resident’s privacy and confidentiality are fully respected. The home also needs to ensure that they provide more information and choices around daily living. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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.V254972.R01.S.doc Version 5.0 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.V254972.R01.S.doc Version 5.0 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): 3, 4 (Standard 6 is not applicable) Residents and their representatives can expect the home to provide accurate information about the services it offers. This will protect staff, existing and potential residents. EVIDENCE: The Deputy Manager has been attending a course on dementia. We discussed the mental health needs of residents living at Squirrel Lodge and some residents were identified as possibly requiring further assessment. A pre assessment is available that incorporates all the elements required by Standard 3 of the National Minimum Standards. This identifies the needs of the potential resident. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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, 10. The home places the needs of residents very highly. Needs are identified and actions are in place that should ensure they are met on a continual basis. However some working practices do not respect the privacy and confidentiality of residents. EVIDENCE: Care plans are available for all residents at the home. These are supplemented by Resident’s Daily Personal Care Schedules kept in resident’s bedrooms. The schedule is “ticked off” by carers as the tasks are completed and include some basic instructions on how some tasks are to be done. Care plans are signed and dated by the resident or their representatives. Some information is minimal, for example an entry under “personal care” reads “(residents name)…needs full care”, however there is no explanation of what “full care” is or what it might include. In another a nutritional risk assessment has been completed and the resident was deemed “at risk”, however there were no instructions on preventative measures or instructions to minimise the risks. The Deputy said that senior carers records would include this information. There is also no plan for night care. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 10 The Deputy Manager said that they complete the majority of assessments, although they had had no formal training or risk assessment training. However they are currently studying for their NVQ4 in Care and Management. Pressure area body maps and assessments are available on the Care Schedules in residents rooms and the home takes advice from an nurse specialising in incontinence. They are also able to provide the home with courses for staff training. The senior care staff keep a daily care record of each resident which includes any changes, information items, medical log, GP visits and any health changes. Management said that the home tries to encourage more independent residents to go for walks voluntarily although there are no formal records kept to evidence this. They also said that residents used to do exercises to music and they may think about reintroducing it. The Care Schedule is kept in residents’ bedrooms and is often on full display. In rooms that are shared the schedules are kept next to each other. We discussed the confidentiality of this with the Deputy and they explained that this was a tool used to ensure that identified needs are met. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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): 12, 13, 14, 15 A lack of information available to residents does not ensure that they are empowered to make choices or given opportunities for positive interaction and stimulation. EVIDENCE: There are no menus on display at Squirrel Lodge. Residents confirmed that at lunch time they “don’t know” what is going to be served but that they are always asked about tea and there was a choice laid out on the tables. One resident added “ …but it’s not things I would have if I was at home”. The Deputy confirmed that a main meal was cooked at lunchtime and an alternative, like soup, is offered if a resident doesn’t like/want the main course. Residents were positive about the food provided and commented that “a real effort” was made when it was a residents birthday, and “tea is often like a buffet”. Residents confirmed that they are able to eat meals and have drinks in their bedrooms, communal areas or the dining room. Residents talked about singers who had visited the home for a performance the day before the inspection. They said that they had enjoyed it “very much” and looked forward to it happening again. One resident who has lived at the home for several years said that they always enjoyed the home a Christmas time as there was “lots going on”. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 12 There is no official activities timetable for the home. Discussion with staff and residents confirmed that people would like to do more. Bingo sessions are organised but people said other things like walks, musical exercise and a ball games that used to be organised don’t happen anymore, as staff are now “too busy”. This concern has also been highlighted in the section called “Staffing” further on in this report. Care planning does not reflect resident’s need for interaction or stimulation. Two residents said that they would like to be accompanied on walks as they were not very confident about going out alone. Another said they would like to go to the shops but had no one to take them. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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): These standards were not fully inspected at this visit. EVIDENCE: Not applicable. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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, 20, 21, 22, 23, 24, 26 Squirrel Lodge continues to be well presented and have a very homely atmosphere. A lot of thought and consideration has gone into the homes recent development, however some health and safety shortfalls have been identified that may place residents and staff at risk. EVIDENCE: The home has 16 single and 3 shared rooms, 18 of which have en-suite toilet and washing facilities. The remaining bedroom is close to one of the homes four communal toilet/bathrooms. All accommodation is on the ground floor with three lounge areas and a separate dining room. The home has recently completed building work on a new office area and laundry. They are now able to have a wet and dry laundry so that the risk of cross infection between clean, dry clothing that needs sorting or ironing is not in contact with any dirty laundry. Staff and residents said that they the additions had improved the home overall. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 15 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. One resident said they enjoyed tending the garden in front of their bedroom. The garden is 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 happily about the pictures they had on their walls and the view from the window. Some health and safety concerns were noted during an environmental tour of the home: 1. Twelve items of personal hygiene products were left on the top of a toilet cistern in one bathroom. 2. Some emergency cords do not reach the floor, which may leave a resident unable to ring for assistance if they have fallen. 3. Door wedges are still being used, although there are agreements and risk assessments with residents. The home has introduced automatic closures in most of the home and is finalising plans to complete the rest. 4. An emergency exit had a security catch which would have been difficult to open in an emergency. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 16 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 Resident’s benefit from staff who are knowledgeable about their jobs and responsibility and enjoy their work. However staff and residents are placed at risk when mandatory training is not updated. EVIDENCE: The home currently uses an outside provider for it’s induction material which includes videos and work sheets. The Deputy Manager confirmed that Moving and Handling training updates are needed and the home is trying to source training or will look at “train the trainer” courses so this may be completed “inhouse”. The Deputy also talked about the importance of “practical training” to ensure staff are doing things correctly. The Deputy Manager supports care staff through induction and foundation training. They are then put forward for NVQ training, although they had some concerns as some funding which was assisting with the cost, had recently been withdrawn. One care worker said that they felt “…like I have an identity. I am qualified”. Staff talked knowledgeably about their roles within the home. They discussed their approach to the changing needs of residents and were clear about procedures for reporting concerns, incidents and accidents. They commented positively about working as a team, although they all said that sometime they felt stretched and could not always spend as much time with people as they wanted. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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): 33, 37, 38. Residents can expect the home to put their immediate care needs first. However they do not benefit from the delegation and organisation of some tasks, which may overlook some aspects of care provision. This does not reflect the stated overall aims and objectives of the home. EVIDENCE: Carers at Squirrel Lodge Staff are responsible for both domestic and care duties. They are very clear that the home puts the needs of residents first and that that “is the most important thing”. However staff expressed concern that the resident’s needs have been increasing and three residents said that they often did not ring their call bells as the staff are “always very busy”. Staff agreed that they felt that sometimes they wanted to sit down and “listen to a resident, but we don’t get the chance”. They also said they would like to have more opportunities to be able to take people out, for short walks or longer visits. More examples of this can be seen in the section called Daily Life and Social Activities. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 18 Carers and residents were able to tell us about how the home is run. They felt able to approach and discuss things with the homes owners who are 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”. Despite these concerns feedback about the home was generally positive. Carers felt that senior staff are supportive and that the home provides “good care”. An Administrator has joined the team at Squirrel Lodge. 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. A new cook has also joined the home. As the owners are usually present at the home on a daily basis there is currently no need for them to complete monthly reports (Regulation 26), however they have keep in contact with the CSCI and provided a progress report of ongoing issues and development in the home. Some health and safety shortfalls were identified during an environmental tour, evidence of which is detailed in the section called Environment. Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 4 3 3 3 3 X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X 2 2 Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP8OP7 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. The home must develop the provision of activities on offer within the home both on a 1:1 and group basis, to promote stimulation through interaction The home must ensure that care planning and other confidential information about the resident is kept securely and does not compromise their privacy and dignity. Menus must be made available for all residents. This must include information on choices for breakfast, dinner, tea and supper. Any alternatives should also be listed. Individuals’ personal hygiene products must not be left in communal areas. The home must ensure that mandatory training is up to date for all care workers including DS0000064004.V254972.R01.S.doc Timescale for action 31/01/06 2 OP12 16(2)(n) 31/01/06 3 OP10OP37 12(4)(a) 31/01/06 4 OP15 12 31/01/06 5 6 OP26 OP27OP38 OP30 13 13 28/09/05 31/01/06 Squirrel Lodge Residential Home Version 5.0 Page 21 7 8 OP38 OP38 12, 13 12, 13 moving and handling. Fire exits must be able to be opened immediately Emergency cords must reach the floor where they are fitted, e.g. bedrooms, bathrooms and lounges. 28/09/05 28/09/05 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 OP7OP8 OP7OP37 Good Practice Recommendations The home should introduce information onto care plans about residents night-time needs. The home should formally review it’s processes and around care planning and risk assessment to ensure that all staff understand their role in meeting individuals needs and that records are clearly linked. The home should ensure that pre assessments and risk assessments are completed by staff who are trained to do so. The daily routines of the home should be formally reviewed to ensure the domestic tasks allocated to carers do not detract from meeting needs of residents. 3 4 OP8OP11 OP33 Squirrel Lodge Residential Home DS0000064004.V254972.R01.S.doc Version 5.0 Page 22 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. 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