Inspection on 01/07/08 for St Luke`s Lodge

This inspection was carried out on 1st July 2008.

CSCI found this care home to be providing an Adequate service.

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

St Luke`s Lodge 21/06/07

St Luke`s Lodge 11/01/07

St Luke`s Lodge 02/05/06

St Luke`s Lodge 25/10/05

St Luke`s Lodge 30/11/04

St Luke`s Lodge 28/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE St Luke`s Lodge 7 Southborough Road Surbiton Surrey KT6 6JN Lead Inspector Claire Taylor Key Unannounced Inspection 10:15 1st & 2nd July 2008 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 St Luke`s Lodge DS0000013399.V366526.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. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Luke`s Lodge Address 7 Southborough Road Surbiton Surrey KT6 6JN 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) 020 8399 2085 anna.raja.sll@gmail.com Mr Christie Kamalanathan Rajanayagam Mrs Annapoorani Rajanayagam Manager post vacant Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE(E) (of the following age range: 65 years and over) The maximum number of service users who can be accommodated is: 17 21st June 2007 2. Date of last inspection Brief Description of the Service: St Luke’s Lodge provides care to seventeen older people, some or all of whom may have dementia. The home is a detached property situated in a quiet residential area of Surbiton. There is good access to shops, public transport and other local resources. The home is owned and managed by Mr and Mrs Rajanayagam. Bedrooms are provided over three floors, all of which can be accessed by passenger lift. There is a large well-kept garden to the rear of the property. Parking spaces are available. Twenty-four hour care is provided. As well as care staff, the home employs a cook and activities coordinator. A copy of the home’s Service User Guide and Statement of Purpose can be obtained on request from the home. Fees for the home ranged from £437.62 to £560.00 and were correct at the time of this inspection. There are additional charges for social trips, hairdressing, newspapers, chiropody and some toiletries. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was undertaken over a day and a half. There were 13 people living in the home at the time of our visit. An expert by experience was invited to take part in the inspection process and accompanied us on the site visit. An expert by experience is a person who has a shared experience of using services and can help us get a better picture of what it is like to live in a care home. Key parts of the report compiled by the expert by experience have been used as evidence to support our judgements. Time was spent meeting with residents to discuss what it is like to live at St Luke’s Lodge. Discussions were held with some of the staff on duty, the owners and their son who is employed as assistant manager for the service. Various records were looked at in relation to care planning, staffing and the way the home is run. We also looked around the building. As part of the inspection we send out an Annual Quality Assurance Assessment (AQAA), which is a written self-assessment that the registered person must complete every year. It is used to tell us how well the home is meeting the National Minimum Standards, what has been done to improve the service since the last inspection and what still needs to be done. The AQAA was returned when we asked for it and provided us with good information about what the service does well and where it needs to improve. Some details from the AQAA are included in this report. Following an anonymous complaint, we also carried out an additional visit in January of this year and again, some of the findings are included. “Have your say” questionnaires were sent to people living in the home and six residents returned their comment cards, three of who were supported by a member of staff. We also met with one visiting relative and left questionnaires for other relatives at the end of the inspection. Three staff and one relative also returned questionnaires. The people who live at the home prefer to be known as residents, so that is the term that has been used in this report. We would like to thank the residents and staff for their time, assistance and hospitality. What the service does well: Prospective residents and those that are close to them are given up-to-date information so that they can make an informed choice regarding the suitability of the home. The admission procedure is thorough and the home will not admit people unless it can provide the level of care and assistance that someone requires. The home keeps good links with a range of health care professionals to ensure that residents’ care needs are met. The home has a fairly stable St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 6 team of staff, some of who have worked there for some time which helps retain some form of consistency for people who have memory impairment. Staff spend time with the residents and have gained an understanding into their individual ways. The staff team manage the daily activities well and provide opportunities for residents to maintain links with the local community. Staff went about their duties in an efficient way and engaged with residents in a caring and respectful manner. One staff said, “I have all the knowledge and experience to meet the needs of service users. I know them very well and do the best I can to help them.” One resident said to the expert by experience, ‘I can’t fault what ‘they’ do for me.’ Another said ‘I like it here, it’s where I am.’ One relative who completed a survey thought the staff always had the right skills and experience to look after the residents properly and one wrote, “I am very impressed by the support and care my …… is given.” Six people living in the home gave positive responses on our comment cards about the standards of care at St Luke’s. The home provides residents with clean and comfortable surroundings and most bedrooms that we saw were decorated to a good standard. They were furnished in a personalised way that helps people with memory loss to retain a sense of identity and comfort. The owners had a positive approach to the inspection process; they are aware of the shortfalls in the service and show a willingness to work with us to maintain and improve standards. What has improved since the last inspection? Following our last two visits, the home has addressed the required areas for improvement. In particular, the service has made good progress to use a more person centred approach for meeting the needs of people who have dementia. Care records have been written in a way that is more personal to the individual concerned. Although some further work is needed in relation to care planning we have seen improvements. Staff have received training that is appropriate to the specific needs of the people who live there and some areas of the physical environment have been adapted with signs to aid independence. Information about the home has been updated and also produced in other formats to meet specific needs. More activities have been arranged to suit the needs of the residents and provide interest and stimulation both within the home and out in the local community. There is an activities information file that contains photos for residents to look at and help them choose what they would like to do. The expert by experience reported, “It was obvious that efforts had been made to change practices. Changes were evidenced in the way in which staff interacted with residents and occupied them in enjoyable ways.” Menus have been improved; they are available in larger print and photos of the meal are displayed daily for people to see. Some improvements have been made to the décor internally- three bedrooms have been redecorated and re-carpeted. In the lounge, the carpet has been replaced and a second television provided. Two of the bedrooms have also been refurnished. A raised flower bed and pond has been built in the rear garden. Residents and those close to them have been given questionnaires to seek their views about the services provided. There was a high percentage of “very St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 7 satisfied” responses and there were no negative comments noted. One relative wrote, “Overall the staff and owners are very caring and responsive to the residents needs. I am pleased with the care and attention that my …… receives.” A resident responded, “I like it here because of plenty of rooms to move about.” There is also a business plan for the coming year that outlines the home’s intentions to improve outcomes for people using the service. Each person is given a contract and statement of terms and conditions so that they know what to expect from the service. Medication systems have improved and regular checks are carried out to ensure safe practice. Disposable equipment including gloves and aprons were available and being used for appropriate tasks. What they could do better: Progress has been made to improve the outcomes for people living at the home, but further work is required to ensure good outcomes. We found areas of improvement that relate to the home’s standard of record keeping. This also applies to some aspects of record keeping required by law. General improvements will ensure that the rights and best interests of people living in the home are more fully safeguarded. Although the care plans were more person centred, they were generalised and sometimes lacking in the precise detail of the care that staff were expected to provide. Similarly, risk assessments covering key areas such as fall prevention need more detail so that staff can safely support each person’ with their mobility needs. Records are needed to explain why some people are unable to have door keys as such restrictions could be construed that residents are not fully able to exercise their rights within the home. Likewise a risk assessment is needed for locking the front door. Although the food menus are more accessible to people, they must show that individuals have a choice of meal and that their preferences are taken into account. Training did not cover the host local authority’s safeguarding procedures and guidance. All staff need to be trained so that they know how they should respond in line with the correct procedures for safeguarding residents. A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. This will give further assurance that people have a safe and comfortable place to live. The home’s policies and procedures need to be reviewed and include any revised legislation. Staff need up to date policy guidance to underpin good practice and ensure that the rights and best interests of the residents are more fully safeguarded. Some staff were working excessive hours, which may put residents at risk. The owners must ensure that all staff have adequate breaks and that the shift patterns comply with the legal requirements of the Working Time Regulations. In addition, duty rotas must be written more clearly so that they provide an accurate and true record of staff working in the home. Generally, residents are being safeguarded by staff recruitment procedures. However, the providers are reminded that all the required records must be held and all staff must complete a health declaration to verify their fitness to work. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 8 We need to be kept informed of any events that affect the well being of people living in the home. This is so we can track incidents and monitor whether the home has made the correct choices when dealing with events that could have put people at risk from harm. Management must therefore ensure that both they and all staff are familiar with the required guidance under regulation 37. Generally, people have some specialist equipment that encourages and promotes their independence. Call bells must be more accessible to people however and the signs in the passenger lift renewed. In addition, the home should arrange for an Occupational Therapist to reassess the home’s suitability for meeting people’s needs. This will show whether further adaptations or equipment are needed. Risk assessments concerning the premises and safe working practices are needed. This is to show that all hazards have been identified and acted upon to prevent people living and working in the home from coming to any harm. As well as the Regulations and National Minimum Standards for Care Homes for Older People, attention is drawn to various guidance and information documents that are available to service providers on our website. (www.csci.org.uk). 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. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 9 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 St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 10 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): 1, 2 and 3 Standard 6 is not applicable to this home as it does not provide intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides good information about the services offered and introduction opportunities so that people can decide whether the care home can meet their support and accommodation needs. People have an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. EVIDENCE: Since our last inspection, the Service User’s Guide has been updated to include the required information about the home and also produced in larger print. Details about fees were available and the guide has been adapted in a more accessible way to tell people about the facilities and services that the home St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 11 provides. For example, the home has made an audiotape for the benefit of those people who cannot read. Planned improvements noted on the AQAA said, “Explore options for Braille translations of service user guide, contracts & brochure.” The home also has a leaflet that summarises the aims of the service. The expert by experience looked at the leaflet and reported that it “ needed upgrading, particular the style and size of font. In any renewal it is suggested that residents are involved.” The AQAA also stated, “Potential admissions books that acknowledges details of perspective clients – clients are given a service user guide and brochure of the home when they make an enquiry – service user guides may be e-mailed, posted, or collected in person.” Feedback from people spoken to and most of the written comment cards told us that individuals had enough information to help them when they moved. We looked at care records for two people who had recently moved to the home. The manager undertakes the pre-admission assessment. This is usually completed with the resident, his/her relative or representative and if appropriate, any other relevant professional associated with the referral. The admission process includes a questionnaire to establish any personal preferences of the new resident as well as a personal history profile that covers key areas and events in a person’s life such as their childhood, adulthood and retirement. The assessment includes about the person’s medical and social history background and details of specific care areas such as nutrition, skin care, medication and mobility. There were details about where the person was independent in meeting their needs. Personal care needs arising from culture and diversity were identified through a questionnaire provided by the home. Examples seen included details about people’s preferred religion or beliefs and identity. Care records showed that assessments took place before people move to the home and where appropriate, some also contained information, which had been provided by Social Services. The home’s assessments provided social and personal information, which would inform the staff and help them to deliver person-centred care if transferred to the resident’s care plan. We saw that the files included a copy of the terms and conditions (or contract) for living in the home. As we previously required, the contract now details what the person is expected to pay and includes accurate information about the facilities and services that people can expect to receive. Where care is funded by social services, contracts are also agreed between the local authority, the home and the resident. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 12 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 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have meant that care plans are more person centred although more detail is needed so that individual needs can be fully met. People are supported to take risks that promote their independence although again, plans need more detail to fully safeguard individuals from potential harm. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. EVIDENCE: The AQAA stated, “Staff have undertaken further training in person centred care. Service user care plans have been updated and include a personal history as well as a questionnaire of their social preferences.” We looked at care records for five people living in the home. Previous inspections required the home to improve upon the care planning process and record keeping related to people’s care. We saw that good progress has been St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 13 made by the home to use a more person centred approach in the delivery of care. To enable staff to gain a better understanding of a person’s life story, the general manager has introduced ‘character profiles’, obtaining information from residents themselves and their relatives or friends where possible. Such information about a person’s life history and interests can be particularly useful to staff when engaging with people who have memory impairment. Monthly reviews were taking place and any changed needs were clearly documented in people’s care plans. Records showed that keyworkers are now expected to review care plans on a monthly basis and up date them accordingly to reflect any changes in needs. Although the care plans covered all the aspects of daily living, they were generalised and sometimes lacking in the precise detail of the care that staff were expected to provide. Plans must be based upon the assessed needs and reflect the desired outcomes of planned care for residents. In addition the care plan must be based upon and developed from the needs assessment. Risk assessments covering key areas were in place although it was not always clear what support residents required with their mobility needs or on preventing the risk of a fall. Risk plans need to be expanded upon and more detailed to reflect individual mobility needs and orientation around the home. This is so that staff have full information on appropriate interventions and how to support a resident. Each risk assessment must specify the risk; possible consequences of the risk; and action required to minimise it. Other risk assessments were in need of review and this must also be addressed. Residents have access to other NHS services as their needs so determine including optician, chiropody, dentist, district nurse, hospital clinics and consultant psychiatrist. Entries related to healthcare appointments were recorded in each resident’s progress notes although it would be better if healthcare records were kept together separately. This would then provide staff with an overall summary of a person’s specific healthcare needs and medical history. It would also enable staff or other professionals to quickly track any events if they have concerns about an individual’s health. Nutritional records were in place such as monthly weight charts for residents. Six responses to our surveys said that people ‘always’ receive the care and medical support they need and one person indicated ‘usually’. People’s preferences about how they receive personal care were recorded in the plans we saw. The home uses a general tick box chart for all residents to record when personal care is given. We therefore suggest that such information is recorded separately within each resident’s care plan so that delivery of care is more person centred. The medication was stored securely in a locked trolley that was locked to the wall in the inner hallway. The home uses a monitored dosage system with most medication being delivered in blister packs by the dispensing pharmacist. We saw that records for the receipt, return and disposal of medication were in good order. Records confirmed that the manager and six staff are trained to administer medication, having completed a course run by Opus Pharmacy services in October 2007. We spoke with one staff during the lunchtime medication round and they showed some good knowledge and understanding of the medicines that people were prescribed. To ensure that the correct St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 14 treatment regime is followed and based upon their needs, the G.P. reviews residents’ medication regularly. We suggest that the home develops medication profiles for each resident that outlines what the medicines are prescribed for. This will provide staff with on hand information about the current medicines prescribed and why they are used. Staff were observed to treat people with respect and to assist with personal care in a discreet and dignified way. Staff spoke to residents in a friendly and polite manner, using their preferred names. People said that they were generally pleased with the care and attention they received. One relative wrote, “My …… is very well cared for.” A visiting district nurse gave complimentary views about the home, as did another relative who we met during the visit. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 15 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- 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and on the whole, activities are offered to suit their individual needs and expectations. Visitors are welcomed to the home and residents are supported to keep in touch with their families and friends. People have nutritious and attractive meals and snacks, at a time and place to suit them although some improvements will further ensure that individual choices are taken account of at mealtimes. EVIDENCE: In response to our last inspection, the home has made good efforts to increase the range of activities for residents that meet their needs and chosen interests. The AQAA said, “Introduced an activity questionnaire to the residents to specifically establish what our residents enjoy doing. Introduced a character profile questionnaire to help us find out what activities the service users may or may not be interested in participating in. Motivating service users to get involved in purposeful activities. Created more opportunity for residents to get involved in activities.” We saw records known as a ‘social care St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 16 plan’ that included specific details about a person’s social needs and preferences regarding their leisure time and hobbies. One example said, “I love cooking” and another, “enjoys dancing, singing and a walk in the garden.” For another person, it was important to them that they carried their soft toy dog around. Staff organise activities for residents and these are mostly offered during the mornings. The home also has an activities co-ordinator who is employed for 3 days a week. Daily activities were written up on a notice board in the main lounge. The AQAA stated that there are plans to “Introduce an illustrated activities board.” Regular activities include bingo, music, quizzes, skittles and gentle exercise sessions. One person we spoke to said that they were able to watch their own DVD films that they had brought with them. Monthly trips are arranged outside of the home and events have included an outing to see the Christmas lights in Oxford Street last year and more recently, a visit to a local wildlife park. Events are celebrated in the home such as birthdays and special occasions. A party was held earlier in the year to celebrate St George’s Day. The expert by experience reported: “In the lounge support staff were engaging residents in a variety of activities, including a game of ping-pong, colour coding pegs and the use of flash cards of everyday objects. The armchairs were mainly arranged in rows against the walls but there was flexibility for small group quizzes, discussion and for watching the three television sets. The lounge had alcoves that enabled this flexibility.” People are regularly consulted so that staff can plan activities that individuals want to do. At the last house meeting, we saw that residents had requested for a barbecue event and the staff were making plans to organise one later in the month. Five people who completed a comment card said that there were ‘always’ activities in the home that they could take part in and another said that there ‘usually’ were. The assistant manager had started an information file about available activities as well as trips that the home had organised. This was a good resource as it contained photos for residents to look at and help them choose what they would like to do. As we suggested at our last visit, the home has begun to offer people more opportunities to get involved in day-today ‘purposeful’ activities. Some of the residents had taken part in a gardening project and planted seeds to grow vegetables such as lettuce and tomatoes. The expert by experience reported, “The square kitchen does not contain access that residents could use to assist with baking. A lower level surface would enable those who would like to, to sit and help with food preparation and baking.” Given that some residents have expressed an interest in cookery, the home should therefore consider creating an accessible area in the kitchen. Planned improvements on the AQAA said, “We are going to try pilot an inhouse ‘shopping trolley’ whereby the residents can have the experience of buying their own items of personal toiletries and confectionary – providing them with the independence, choice and autonomy of what and how much they buy.” The expert by experience reported, “There remained improvements that could enhance the lives of residents, and these might include a regular visiting mobile library. One resident stated that she loved reading but needed large St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 17 print. There was one newspaper available in the lounge but no evidence of reading materials readily within reach of residents.” In addition, A relative wrote, “ A more active programme would give more choice.” Our view is that the home could therefore improve upon its activity programme further. People we spoke to told us that they are able to have visitors whenever they want. Relatives told us that they are always welcomed into the home. One relative wrote, “I always have access to my ‘……’ by phone or when visiting.” Records confirmed that staff support people to maintain relationships and social links with those that are close to them. Any dietary needs were clearly recorded in the care plans and residents’ weights are monitored monthly. Each person’s food preferences were clearly recorded. One example said, “Favourite meal is roast meat and potatoes.” Another entry stated, “Likes hot chocolate mixed in with her coffee.” Following our last inspection visit, the menus have been improved although some further work is needed to promote people’s choice and independence at mealtimes. The daily menu was displayed in large print on a white board in the lounge. There was a photo of the meal to help residents recognise the food being offered. We had an opportunity to sit with some of the residents over lunch and the atmosphere was relaxed and unhurried. Some residents required assistance to eat and this was given discreetly, with staff supporting those individuals. The expert by experience reported, “While on the visit, lunch was served and it was served hot. Residents, on being asked, all stated the lunch was ‘lovely.’” One relative wrote, “The food is excellent.” People who were spoken to were not aware however that they could choose an alternative if they did not like what was placed in front of them. The assistant manager advised that if a resident did not feel like eating, the food would be left in the kitchen and reheated if it was wanted later in the day. We were told that should people want an alternative meal this would be provided. If residents do not know what the meal consists of until it is actually served, this limits their choice and would cause a delay whilst an alternative is prepared. The expert by experience reported, “One resident was taken from the dining table and helped into a lounge armchair and a member of staff helped the resident to eat. It was apparent that there was no interest in the food and the staff member stated that this was often the case as the resident preferred sandwiches.” Menus therefore need to show that people are offered a choice of meal each day. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 18 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 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The home’s practices generally safeguard residents although some policies must be improved upon to maximise protection for people living and working in the home. EVIDENCE: St Luke’s Lodge has a complaints procedure, which outlines how a complaint would be dealt with and the timescales for action. The complaints procedure is included in the Service Users Guide. The home keeps a record of any comments or complaints made about the service in a book. Six people who completed surveys said that they knew how to make a complaint. One relative also confirmed that they knew how to raise concerns. Since the last key inspection in June 2007, there has been one anonymous complaint made to us about the service. We therefore visited the home in January 2008 to look at the concerns raised. Our report stated the following; We saw that the afternoon tea and biscuits were seen to be sufficient for people who use the service. Weight records did not indicate any concerns with people losing weight. The communal areas and entrance of the home were fairly fresh and clean. People who use the service were seen to be generally well kempt and St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 19 well presented. Staff were seen to respond to people in a caring and appropriate manner. We therefore found that the concerns raised were not substantiated. For what the home could do better, the AQAA stated, “Produce numerous copies of the complaints procedure in large print and with visual aids. In recognising that we have received no formal complaints – we could introduce a queries/ concerns book where we can record any queries that are raised with us (verbally) and our reaction to these concerns.” Staff spoken with were aware of different types of abuse and said they would report any concerns to the manager. From the staff training records, we saw that the majority of staff have received in house training on abuse awareness and safeguarding. The local authority safeguarding policy and procedure from the Royal borough of Kingston was available in the home. Records showed that there had been several incidents of physical aggression concerning one resident who has since left the home. On one occasion, this person hit another resident causing a facial injury. Although the manager and staff had taken prompt action to review the person’s needs, the incident was not reported to the local authority safeguarding team. This must be done to ensure that the correct procedures for safeguarding residents are followed. The manager should therefore reintroduce the policy to staff so that they are aware of the correct guidance on how to refer concerns of this nature to the local social services department. Staff also need to update their training on abuse awareness and safeguarding as organised by the Royal borough of Kingston. In addition, the procedure for dealing with aggression was dated 2003 and should be reviewed to ensure the safety of residents and staff, in the event of an aggressive incident. This has been discussed further on in the report under management and administration as the majority of polices and procedures are now in need of review. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 20 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, 22, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home makes sure people have the right specialist equipment that encourages and promotes their independence. To improve upon this however, call bells must be more accessible to people, the signs in the passenger lift renewed and the premises assessed for suitability to accommodate wheelchair users. The home is clean, hygienic and generally kept in a good state of repair so that residents live in a well-maintained environment. EVIDENCE: Since our last inspection, there have been some home improvements within the premises. In the lounge, the carpet has been replaced and a second small television provided. Some of the bedrooms have also been redecorated and refurnished. A raised flower bed has been built in the rear garden and the pond St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 21 fitted with a safety beam and surround netting. The expert by experience reported, “The garden was large with a well-kept lawn and was accessed via a ramp or steps. It was a warm summers’ day and the patio doors were open. Benches were arranged on the patio to facilitate interaction. Three residents were outdoors and while the pork paprika was sizzling in the oven the cook joined the residents.” We saw that some areas of the home aim to help people with dementia or short-term memory loss to maintain their independence. Picture signs were on toilet and bathroom doors and each resident’s bedroom door was named. During this visit, the weather was particularly warm and the owner set up portable fans in the communal areas. As highlighted at our last inspection, the armchairs in the lounge were still arranged in rows against the walls and could be changed around to create a more homely feel. The home might consider replacing some of the chairs with sofas so that people can sit together more closely if they so choose. Some bedrooms were seen with the person’s agreement, and aside from one, most were decorated to a good standard and furnished in a personalised way. One resident said “I have everything I need” and another described their room as “comfortable”. One person said that they had no hot water for their bedroom sink. We therefore raised this issue with the owners who took action to fix the problem. The manager advised that most of the furniture is supplied by the home, but residents can bring in their own belongings to make their rooms more personal. Bedrooms viewed had personal photographs and items that were meaningful to the person and brought them a sense of comfort and identity. One person had a fondness for cats and had various pictures and ornaments around their room. One of the bedrooms was in need of some repair and redecoration. We discussed this with the owners during the visit who advised that there was an ongoing redecoration programme. This needs to be recorded in more detail to show how the providers keep the home in a good state of repair and makes any necessary improvements to the upkeep of the building. Planned improvements on the AQAA stated, “Re-paint woodwork in the hallway and resurface flooring in the hallway. Upgrade the ground floor bedrooms.” The expert by experience reported, “There were areas of St. Luke’s that would be difficult to access for wheelchair users. An occupational therapy assessment would be helpful to provide support on dealing with access issues.” The expert by experience reported, “The lift was a four-person carrier. The call buttons required colour coding and needed a raised area on each. The signs stating the floors required needed renewal. A mirror on the back wall would assist with knowing who was waiting to enter.” The lift is therefore in need of refurbishment to increase independence for residents and minimise any confusion. We also saw that call bells were out of reach in two residents’ bedrooms. In addition, the expert by experience reported, “Call buttons were fixed to wall space behind armchairs that made them difficult to locate.” All call bells must be accessible to people so that they can summon assistance as necessary. Some residents are provided with keys to their bedrooms but for safety reasons and to minimise the risk of residents entering other people’s rooms, others do not hold keys. Information must detail why some people are unable St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 22 to have keys as such restrictions could be construed that residents are not fully able to exercise their rights within the home. The manager must therefore complete individual risk assessments and review the locked door policy. The new keypad entry system on the front door also needs to be reflected in this policy. There are adequate toilets and bathrooms situated throughout the building, with some bedrooms having ensuite facilities. The home was clean and tidy with good hygiene practices in place and suitable hand washing facilities available to both residents and staff. People responded on their comment cards that the home was “always” fresh and clean. Protective clothing was available to staff and appropriate arrangements were in place for the safe storage and disposal of clinical waste. Following a recent Food Hygiene Inspection by the Environmental Health Department the home was awarded a four star rating (out of a possible 5 stars), which is commendable. We saw that the local fire authority carried out an inspection of the property in April of this year. The fire safety report confirmed that the premises were satisfactory. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 23 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): 27-30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people are supported by an appropriately staffed team. Staff must not work excessive hours however as this may put residents at risk. Good recruitment practices are in place to ensure that people are cared for and protected. Record keeping needs to improve however as a further safeguard. Improved training for staff has resulted in a more skilled workforce to meet the residents’ needs although more staff still need to achieve the required NVQ level 2 qualification. EVIDENCE: There were suitable numbers of staff to meet the current needs of the residents although this should be reviewed if the home becomes fully occupied. Staff allocation allows for three carers to be on morning duty, two to three in the afternoon and two waking night staff. Ancillary staff consist of one contracted cook and a part time cleaner. We looked at some staff rotas, which showed that some staff regularly worked an 18-hour shift that included a waking night. Staff must not work excessive hours, as this may put residents at risk. The provider must also demonstrate that staff have adequate break time and develop a policy. Attention is drawn to the required legislation under the Working Time Regulations 2003. The duty rotas did not provide an St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 24 accurate record of who worked. Rotas were written in pencil and did not identify the full names of the staff or who was in charge. This must be addressed for better clarity and legal purposes. There are recruitment procedures which ensure that staff are vetted correctly before they begin work. We looked at records for four staff and these contained most of the required legal checks and documentation. One additional check was needed however; that all staff must complete a health declaration to verify their fitness to work. The information seen was generally satisfactory and evidenced areas of good practice in relation to recruitment. For the newest member of staff, a POVA (Protection of Vulnerable Adults) first check had taken place but the full CRB (Criminal Records Bureau) disclosure was still awaited. The assistant manager was aware that until a full CRB is held no employee can work unsupervised. Discussions with staff and written comment cards confirmed that appropriate pre-employment checks were undertaken. Evidence was seen that three staff have been enrolled on an NVQ 2 course, two have completed with one staff studying for the level 3 qualification. The manager explained that two staff who held the NVQ training had recently left. Progress will be checked during the course of future inspections, as the home does not meet the required standard for numbers of trained NVQ staff. Residents and staff appeared relaxed in each other’s company and staff treated individuals with respect and dignity. One relative who completed a survey thought the staff always had the right skills and experience to look after the residents properly and one wrote, “I am very impressed by the support and care my …… is given.” Residents commented positively about several longstanding care staff. One resident spoke to the expert by experience about the assistant manager ‘He’s a lovely man.’ ‘He’s very caring.’ Of the six residents who completed surveys, three said that staff were ‘always’ available when they needed them and three said ‘usually’. In response to our last inspection, some further training has taken place. In May of this year, staff attended a course on person centred care and dementia awareness. The manager had also accessed the Common Induction Standards published by the Skills for Care Organisation. This is designed to help ensure that all new staff entering into the care industry undergo a minimum level of initial training. We saw completed inductions on the four staff files. Three staff who completed comment cards said that the training was relevant to their role. The mandatory training is carried out by one of the owners, Mrs Raja, who organises training for staff in topics such as first aid, food hygiene, fire safety, challenging behaviour, moving and handling and infection control. A planned training programme was in place for staff to attend relevant courses throughout the forthcoming year. Some of the training is accessed externally, through the local authority. Staff who completed comment cards said that the home also provided DVD s to watch as a method of learning. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 25 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, 33, 35, 36, 37 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been improved upon to ensure that quality of care is regularly appraised so that the home is run in the best interests of the residents. Some improvements with record keeping are needed so that the rights and best interests of people using the service are more fully safeguarded. Some health and safety practices need improving to ensure that the environment is safe for residents and staff. EVIDENCE: The owners have been running the home for a number of years and continue to take responsibility for its day-to-day management. As assistant manager, the owner’s son has become more involved with the administration duties and St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 26 running of the home since our last visit. He advised that the home was looking to appoint a new manager or he might apply to register with us. Plans on the AQAA said, “Look into options for recruiting an NVQ level 4 deputy manager with a view to grooming them to be the next manager of the home.” Progress will be checked during the course of future inspections as the home is currently without a registered manager who has achieved the appropriate qualifications. The home has improved upon the systems in place for monitoring the quality of care provided. The AQAA stated, “Have developed a formal system for selfaudit.” We saw an annual business plan for the home that briefly outlines forthcoming developments for the year ahead. In response to the previous requirement, residents and their relatives were given satisfaction surveys in May of this year. An audit of the care was compiled into a report and made available for residents and relatives to read. The report contained a high percentage of “very satisfied” responses and there were no negative comments noted. One relative wrote, “Overall the staff and owners are very caring and responsive to the residents needs. I am pleased with the care and attention that my …… receives.” A resident responded, “I like it here because of plenty of rooms to move about.” We saw that regular meetings for residents take place to ensure that they feel part of the home they live in. We suggest that the home extends its quality assurance practice further by consulting with the staff and other professionals who have an interest in the service. We sampled some staff supervision records. Staff were meeting with the manager every two months and had a yearly appraisal of their job performance. We saw that the majority of the home’s policies and procedures had not been reviewed since 2003. These now need to be reviewed and up dated accordingly to reflect changes in both the home’s practices and any revised legislation. One example concerned the locked door policy for the home as discussed earlier in the report. Staff need up to date policy guidance to underpin good practice and ensure that the rights and best interests of people are more fully safeguarded. We looked at accident records. Some reports lacked information about what action had been taken by the home following an accident. In addition, the Commission needs to be notified about reportable events under regulation 37 of the Care Standards Act. As discussed earlier in the report, there were several incidents involving a former resident whose behaviour challenged the service and affected the well being and safety of other residents as well as staff. These were not reported under the required regulation and management must therefore ensure that all staff are aware of the relevant guidance. Care must be taken to ensure all events are accurately recorded, any outcomes action noted and any untoward incident and/or death are sent to us for tracking purposes. A failure to do so could result in people being put at risk from harm and having their needs unmet. The home keeps a general record of any falls that residents have had. It would be better if the manager carried out a regular audit to identify if any patterns are emerging concerning falls and if particular residents are more prone to these occurrences. In general, the home has a range of systems in place that aim to promote the health, safety and welfare of the people using the service, staff and visitors. There is policy guidance for staff to follow regarding a range of health and St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 27 safety activities but as mentioned earlier, these are now in need of review. The completed AQAA stated that all relevant safety checks were up-to-date. We looked at some of the servicing and maintenance records for the home. The electrical safety certificate for the building had recently expired. The assistant manager took prompt action to address this and arranged for an electrical safety check to be carried out. We were then provided with a copy of the new certificate following our visit. Fire alarms and equipment had been serviced regularly. To show that people refresh their knowledge of fire evacuation procedures, it would be better if the names of staff and residents taking part in a drill were recorded. We saw up to date certificates for gas safety, testing of the water for Legionella, the lift and hoist equipment. Checks on hot water temperatures were being carried out regularly to ensure that they are maintained at a safe limit. We saw a general risk assessment for the workplace environment although further details are needed that are specific to hazards and health and safety practices. Actions to lessen the risk of each hazard need to be clearer so as to ensure the safety and well being of all those living and working in the home. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 28 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 2 2 St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Care plans need greater detail about how a person is cared for and how intended outcomes will be achieved. This is to ensure that staff are aware of how each assessed need must be met and how people prefer to be supported. Risk assessments need to be written in more detail to further safeguard residents’ welfare, particularly regarding the prevention of falls. This is to ensure that potential risks to people using the service and staff are identified and minimised. Timescale for action 31/08/08 2 OP8 13(4)(5) 31/08/08 3 OP15 12(3) Menus need to show that there is 31/08/08 choice and that people’s individual preferences have been taken into account. All staff require additional training in Safeguarding procedures as organised by the local authority. This is to enhance their knowledge and DS0000013399.V366526.R01.S.doc 4 OP18 13(6) 18(1 c (i) 31/10/08 St Luke`s Lodge Version 5.2 Page 30 skill on how to refer concerns of this nature to the local social services department. 5 OP19 23(2 b,d) A planned maintenance and redecoration programme is needed to demonstrate how the premises are kept in a good state of repair and where any necessary and planned improvements are made to the upkeep of the building. People who use the service must be able to access their call bells so that they can summon assistance as necessary. In the passenger lift, the call buttons and floor identification signs need renewal. This is to minimise confusion and promote independence for people using the service. 30/09/08 6 OP22 12(1)(b) 31/08/08 7 OP22 23(2)(n) 30/09/08 8 OP22 23(2)(a) & (n) The premises need to be 30/09/08 reassessed by an Occupational Therapist. This will show whether further adaptations or equipment are needed for meeting people’s needs and supporting their independence. 31/08/08 9 OP24 12(3)(4 a) Each resident must have a risk 13(4) assessment concerning the provision of keys to their bedroom doors. This is to ensure that their rights are protected. 18(1)(a) Staff must not work excessive hours, as this will put residents at risk. Staffing rotas must be recorded in more detail and written in ink so that they provide an accurate and true record of staff working in the home. DS0000013399.V366526.R01.S.doc 10 OP27 31/08/08 11 OP27 17(2) sch.4 (7) 31/08/08 St Luke`s Lodge Version 5.2 Page 31 12 OP28 19(5 b) More care staff need to obtain the NVQ2 qualification in care so that the home meets the required standard. All of the required information must be obtained for staff. Employees must complete a health declaration to verify their fitness to work. Policies and procedures must be updated and reflect any current legislation to further ensure the safety and wellbeing of residents and staff. 31/10/08 13 OP29 18(1) sch. 2 & 4(6) 30/09/08 14 OP37 12(1 a) 30/09/08 15 OP38 17(1)(a) Sch.3 (j) The Commission must be notified 31/08/08 more promptly of all significant events that affect residents well being. This is so we can track that appropriate action has been taken and people are safe. The manager must ensure that all staff are familiar with the reporting of incidents and accidents under Regulation 37 of the Care Standards Act. Risk assessments concerning the premises and safe working practices must be carried out and regularly reviewed. This will show that all hazards have been identified and wherever possible minimised to ensure the safety and well being of all those living and working in the home. The manager must write a risk assessment and develop a policy for locking the front door so that residents’ rights are protected. 31/08/08 16 OP38 12(1a) (2)(3) 13(4) 17 OP38 13(4) 31/08/08 St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 32 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 OP1 OP8 Good Practice Recommendations The brochure about the home is made available in other formats that meet the needs of the residents. Information about when personal care is given should be recorded separately within each resident’s care plan so that delivery of care is more person centred. That records and correspondence relating to each person’s healthcare needs are documented separately. This would enable staff or other professionals to quickly track any events if they have concerns about an individual’s health. Medication profiles should be written for each person and kept with their administration chart. This is so that staff have on hand information about the medicines prescribed and why they are used. Further activities could be arranged that meet the residents’ needs and social preferences as outlined in this report. Mealtimes should be an opportunity for people to interact. Practices such as staff eating with the residents should be considered by the home. To create a more homely feel in the lounge, the owners might consider replacing some of the chairs with sofas so that people can sit together more closely if they so choose. A mirror on the back wall of the passenger lift would assist residents and staff to know who was waiting to enter. Satisfaction surveys should be offered to the staff and other professionals who have an interest in the service. A regular audit of accident records should be undertaken to identify if any patterns or trends are forming e.g. recurrent falls. DS0000013399.V366526.R01.S.doc Version 5.2 Page 33 3 OP8 4 OP9 5 OP12 6 OP15 7 OP20 8 9 10 OP22 OP33 OP38 St Luke`s Lodge 11 OP38 The names of staff and people involved in fire evacuation drills should be recorded. This will further ensure that those taking part have refreshed their knowledge at regular intervals. St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 © 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 St Luke`s Lodge DS0000013399.V366526.R01.S.doc Version 5.2 Page 35 - 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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