Inspection on 25/10/05 for St Luke`s Lodge

This inspection was carried out on 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

St Luke`s Lodge 01/07/08

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 30/11/04

St Luke`s Lodge 28/04/04

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

CARE HOMES FOR OLDER PEOPLE St Luke`s Lodge 7 Southborough Road Surbiton Surrey KT6 6JN Lead Inspector Diane Thackrah Unannounced Inspection 1:15 25 October 2005 th 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.V251313.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. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 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 Mr Christie Kamalanathan Rajanayagam Mrs Annapoorani Rajanayagam Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: St Lukes Lodge is registered with the Commission for Social Care Inspection to provided care to a maximum of seventeen people over the age of sixty-five, six of whom may have dementia. The home is a detached property situated in a conservation area. The home is owned and managed by Mr and Mrs Rajanayagam. Service users have access to shops, public transport and other local resources. Bedrooms are provided over three floors, all of which can be accessed by passenger lift. There is a large, garden to the rear of the property. Parkings spaces are available. Twenty four hour care is provided. As well as care staff, the home employes a cook and two activities coordinators. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on 25 October 2005 between 13.15 and 17.00. A partial tour of the premises took place. Care records were inspected. The owners and two staff members were spoken with. Many of the service users are very frail and do not have the mental capacity to give an accurate picture of life in the home. Time was spent time sitting and chatting with these service users, observing how they were cared for. It is concluded that they appear well care for and they appeared content with life in the home. What the service does well: What has improved since the last inspection? There have been few changes in the home since the last inspection. Training has been ongoing for all staff members, including the Registered Provider. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Luke`s Lodge DS0000013399.V251313.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 St Luke`s Lodge DS0000013399.V251313.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): None of these Standards were assessed during this inspection. EVIDENCE: St Luke`s Lodge DS0000013399.V251313.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, 9, and 10. There are arrangements for ensuring that service user’s needs are identified, this ensures that needs are met. Medication is, in general, handled safely, ensuring that service users are protected. However, there are some issues regarding the handling of medication that are potentially detrimental to service user’s well being. EVIDENCE: Comments from service users indicated that their needs were being met. One service user said, “It’s very nice here” Arrangements for ensuring that the needs of service users are met are generally good. Each service user has a plan of care that has been generated from an assessment of needs. Three care plans were examined. There was detailed information in care plans about how staff members would meet the social, personal care and health needs of each service user. Care plans included information about how service users could be assisted to retain some independence. Moving and handling risk assessments had been carried out. One care plan had a risk assessment St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 10 regarding them having a bedroom on the top floor of the home. There was documentation detailing that care plans are reviewed on a regular basis, and updated to reflect changing needs. Staff members spoken with confirmed that care plans form the basis of the care that they provide to each service user. Care plans included information about health needs, and there were records detailing that nutrition and weight is monitored. There were records detailing that service users have access to health care professionals, including General Practitioners. Opportunities for exercise are included in the home’s activities programme and details about how personal and oral care is to be provided is detailed in care plans. An accident and incident book is maintained in the home. Twenty-two accidents have occurred since the last inspection of the home. The Registered Provider said that accidents are monitored. There are policies and procedures in place for ensuring that medication is handled safely. Medication Administration Records examined were, in general, accurate and up to date. However, Medication Administration Records did not provide information about whether service users had any allergies to medication. The Registered Provider said that this was due to a printing error with the pharmacy responsible for providing the Medication Administration Records. There was no information about allergies in personal records for some service users. A Requirement is made in relation to this issue. One staff member confirmed that they had received training in Intermediate Safe Handling of Medication, and there were records to back this up. There were no records however, detailing that other staff members, responsible for handling medication, have received medication training. This issue must be addressed. All medication was stored securely at the time of this inspection. There are currently no controlled drugs being used in the home, but facilities are available for controlled drugs. The Registered Provider said that there is a good relationship with the pharmacist, who carries out yearly medication checks in the home. Staff members were observed to engage in respectful relationships with service users and those spoken with indicated that they were aware of service user’s rights about being consulted with. St Luke`s Lodge DS0000013399.V251313.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 and 15. There are varied activities and wholesome and enjoyable meals provided. Service users are consulted about meals and activities and therefore differing expectations and lifestyles are well catered for. EVIDENCE: There are good opportunities for service users to be involved in social and recreational activities in the home. Some service users were watching the television, and others were relaxing in the communal lounge at the time of this inspection. There was also bingo and a general knowledge quiz, facilitated by the home’s activities organiser. A large number of service users were joining in with these activities, and appeared to be enjoying them. There are structured activities provided three afternoons each week and a notice board in the lounge details activities on offer. An activities log is maintained and this detailed that in recent weeks there has been a musical quiz, discussion group, gentle exercise, art and crafts and a general knowledge quiz. Care records detailed that staff members support service users to engage in activities that they enjoy. One service user was supported to go to church; others saw a priest in the home. Records also detail that service users have friends and family members that visit the home on a regular basis. There were no visitors in the home during this inspection, however the Registered Provider said that visitors are welcome at all times, but asked to St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 12 avoid visiting during meal times. Details about the visiting policy are provided in the home Service User Guide. A notice board in the dining room detailed that lunch on the day of this inspection was shepard’s pie, carrots and pies, followed by pears in red wine, with cream. One service user spoken with said that this meal had been “lovely” A staff member confirmed that service user’s individual preferences in relation to food are taken into account, and catered for. There was a menu available. Meals on this menu were typically British dishes, and this largely reflects the preferences of current service users. The Registered Provider said that arrangements could be made for specific cultural food to be provided. Hot and cold drinks are provided routinely throughout the day, or on request. There is a pleasant conservatory were the majority of service users take their meals. The kitchen was found to be clean, and regular temperature checks are carried out on fridge and freezers. There was a good supply of fresh fruit and vegetables available. There was a notice board detailing what was for lunch on the previous day. The Registered Provider should ensure that there is a menu displayed, that is up to date, and details a choice. There was a good supply of food in the home, including fresh fruit and vegetables. St Luke`s Lodge DS0000013399.V251313.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): 16 and 18. The home has systems in place for dealing with service users and their family’s complaints. This ensures that service users and their family members know that their complaints will be taken seriously. There continues to be failures in the home’s staff recruitment and training procedures. They are not robust, and people living in the home are not fully protected from abuse. EVIDENCE: The home has a complaints procedure, which is made available in the Service User Guide, and on a notice board in the lounge. There were no complaints recorded in the home’s complaint log. A procedure for responding to allegations of abuse was available in the home. One staff member spoken with confirmed that they had received training in the protection of vulnerable adults. This staff member demonstrated a good knowledge of this training. However, training records indicate that a number of staff members have not undergone such training. A Requirement was made regarding this issue at the last inspection of the home, and is repeated. All staff members working in the home must undergo training in the protection of vulnerable adults. Some staff members have been employed in the home without a fresh Criminal Records Bureau check being made. There was no documentation detailing that a Protection of vulnerable adults list check had be made regarding one staff St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 14 members. This issue is ongoing, and does not ensure that service users are fully protected. This issue is discussed in more detail in Standard 29 of this report. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24 and 26. In general, service users live in a comfortable and clean environment. However, there are a number of shortfalls in this area, which do not promote the welfare of service users, nor provide safe and comfortable surroundings in which to live. EVIDENCE: The home is a large detached property, situated on a quite road close Surbiton town centre. There is a car park at the front of the property, and a large, well maintained garden to the rear. The grounds and garden are tidy and safe and accessible to service users, including those in wheelchairs. The home is decorated and furnished to a good standard, in communal areas, and some bedrooms and there is a routine programme of maintenance and redecoration. The home’s maintenance plan details that there are plans to decorate two bedrooms and the first floor corridor before the end of the year. The kitchen was clean and well organised. The home is laid out over three floors, accessed by lift or stairway. There were records detailing that the local fire officer has St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 16 recently carried out an inspection of the home, and found the premises to be satisfactory. There are three toilets on the ground floor, and further toilets on the first and second floor. Each bedroom has a sink, with a thermostatic valve fitted to prevent the risk of scalding. There are two baths, and a shower. Specialist seats, and handrails are available to assist service users when showering and bathing. All toilet and washing facilities were clean at the time of this inspection. One service user said, “I have a comfortable bedroom” another said “I share a bedroom, which I don’t mind” The bedrooms of four service users were viewed. One bedroom was carpeted and three bedrooms had lino flooring. Two bedrooms were homely in appearance, and contained personal possessions belonging to the service users. One bedroom was bare, and did not appear homely. Another bedroom had wallpaper that was dirty and peeling in a number of places. Each bedroom had a call bell that was in good working order. There were no window restrictor on two windows were there was a risk of falling. One bedroom had an unpleasant odour. Service users are not provided with a bedroom door key, or a locked storage space. The Registered Provider said that these could be provided on request. Details about service user’s views on having a bedroom door key, or a locked storage space should be recorded in care plans. Most areas in the home were clean and hygienic. There is a laundry that was in good order at the time of this inspection. There is no sluice facility. A number of Requirements and recommendation are made in relation to these issues. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. The procedures for the recruitment of staff are not robust and do not provide the safeguards to offer protection to people living in the home. There is no staff training and development programme; therefore staff members are not provided with skills necessary for meeting the needs of service users. EVIDENCE: There were three care staff members, a cook and both Registered Providers on shift at the time of this inspection. Examination of staffing rotas indicated that this level of staffing was usual, with a cleaner working each morning. Staff members were observed to share respectful relationships with service user. Staff recruitment files were examined for a random sample of three staff members. Each file contained identification documentation, visa information, a completed application form, and two written references. For one staff member, references had not been applied for directly by the home, and there were no details about their work history provided in their job application. . Criminal Records Bureau checks were in place for each staff member, however, two staff members had provided Criminal Records Bureau checks, which had been carried out by their previous employers. There was no Protection of vulnerable adults check in place for one of these staff members. The Registered Provider is aware that this staff member must not work St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 18 unsupervised, prior to a Protection of vulnerable adults check being made. Criminal Records Bureau checks are not portable. A new Criminal Records Bureau check, including a Protection of vulnerable adults check, must be obtained for all staff members, prior to them commencing work in the home. There must also be full details about staff members previous work history, and two references, which have been applied for directly from the home. This issue has been ongoing. A fourth repeat Requirement is made regarding poor recruitment practice in the home. Failure to address this issue may result in enforcement action being taken. Written records were available detailing that one new staff member has undergone an induction programme. These detailed that induction training included Food Hygiene, Fire Safety and Introduction to Dementia. Training records detail that training including Dementia Awareness, Fire Safety, Continence Care and Care of Skin has occurred for some staff members since the last inspection. Staff members spoken with confirmed that they were provided with opportunities for training. One staff member said that they had recently completed NVQ Level 2 in Care training. This staff member was able to describe good practice for fire safety and adult protection. There continues to be no formal structure for foundation training in the home. This must be developed and include training in safe working practices, principles of care and the experiences and needs of the current service user group. Records were not available detailing that staff members have undergone training in adult abuse, the safe handling of medication, or moving and handling. The Responsible Individual said that this training has occurred. Records must be maintained of all training undertaken by staff members. The Registered Providers must be clear about what skills staff members have, and when refresher training is needed. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 and 36. There is a quality assurance system is in place and staff members receive guidance through formal supervision. This contributes to service users receiving consistent and quality care. EVIDENCE: An annual development plan was available detailing arrangements for making improvements to the service. Service users and their relatives and friends have recently been asked to contribute their views about the home through a survey. Monitoring the quality of the service occurs monthly with written reports of this monitoring being made available to the Commission for Social Care Inspection. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 20 The Registered Provider said that no money is held on behalf of service users. Toiletries and hairdressing is provided, with receipts and invoices being sent to family members. Staff members spoken with reported that they received formal supervision. Supervision contracts, and records of supervision sessions were available. These detailed that supervision occurs approximately once every eight weeks. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 3 X 2 X 2 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 3 X X St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 22 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 OP9 Regulation 13 (2) Requirement The Registered Providers must ensure that there are records detailing the staff members who have received training in the safe handling of medication. The Registered Providers must ensure that the allergy section on Medication Administration Records is completed for all service users, and there is a record of this in their personal files. The Registered Providers must ensure that training is provided for all staff members in the Protection of Vulnerable Adults. The Registered Providers must ensure that bedroom three is redecorated. The Registered Providers must ensure that there is a window restrictor on each window, were there is a risk of falling. Were there is not a window restrictor; there must be a risk assessment in place. The Registered Providers must ensure that there is not an unpleasant odour in bedroom DS0000013399.V251313.R01.S.doc Timescale for action 01/01/06 2 OP9 13 (2) 01/12/05 3 OP18 12(1)(a) 18 (1)(c) 23 (2)(d) 13 (4)(a) 01/02/06 4 5 OP24 OP24 01/02/06 01/12/05 6 OP24 16 (2)(k) 01/12/05 St Luke`s Lodge Version 5.0 Page 23 7 8 OP26 OP29 23 (2)(k) 2. 19 (b)(i) fourteen. The Registered Providers must ensure that sluicing facilities are provided in the home. The Registered Provider must ensure that: 1. There are two written references, applied for directly by the home, for each staff member, prior to them commencing work in the home. 01/03/05 01/11/05 9 OP30 18 (c)(i) 19(1)(a) 2. There is a Criminal Records Bureau and Protection of vulnerable adults check applied for directly by the home, for each staff member, prior to them commencing work in the home. (Repeat Requirement. Timescales of 01/06/04 and 01/01/05 & 01/05/05 not met) The Registered Provider must: 01/01/06 1. Implement a planned programme of training for all staff members. This must include foundation training that is in line with ‘Skills for Care’ specifications. (Repeat Requirement. Timescales of 01/06/04 and 01/01/05 & 01/05/05 not met) 2.Ensure that all staff members have received training in moving and handling, with records kept. 3.Ensure that all staff members who are responsible for handling medication have received training in the Safe Handling of Medication, with records kept. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 24 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 OP24 OP24 Good Practice Recommendations The Registered Providers should ensure that service user’s views about having a bedroom door key, and a locked storage space are recorded in their care plans. The Registered Providers should ensure that action is taken to provide service users with a more homely environment in which to live. St Luke`s Lodge DS0000013399.V251313.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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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