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Inspection on 04/11/08 for Stroud Green Lodge

Also see our care home review for Stroud Green Lodge for more information

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Good 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has on display a Bill of Rights that outlines thirteen principles upon which the home is to be run. These reflect the National Minimum Standards, such as service users rights to fulfilment, to be involved in decision making and to be consulted. The residents regard this as good home and tell me that it is a nice home they are getting used to living in and that the staff, whom they already know, are very good. As before, no complaints were made during this inspection. The small group living units provide a homely environment in what is a very large building. The staff said that consider their training is very good and includes training for their new role as health care assistants when they move into the new accommodation. We also noted a message from the Chief Executive of London Borough Croydon denouncing racism and reminding staff of the whole council that they have individual responsibility to respect equality and diversity and whilst this notice referred to another department it indicates the intention of the service to treat all service users with respect and dignity.

What has improved since the last inspection?

A number of requirements and recommendations were made earlier inspections and the management team have addressed those matters. Residents now hold their own care plans in their bedroom. These important documents, which were previously kept in the staff office, are now much more accessible to both the recipients of care and those providing it. To this folder has been added the Service User Guide, which every new resident will receive when they come into the home. Shortly after admission a resident was admitted to Stroud and the relatives have highly commend the staff for their care and kindness in helping their relative to settle in so quickly at a time of transition and upheaval for the residents and staff team.

What the care home could do better:

Since both Stroud and Addington both achieved good outcomes few requirements or recommendations arise. It is also to be noted that both services are to be replaced within a small number of years. The registration certificate is now incorrect since it shows that outing managers details, the home needs to request a variation and also needs to register the incoming manager who has transferred from Addington to Stroud. We recommend the rubbish is removed from the rear of the premises without delay. As there was a wooden wedge near the kitchen door it is evident this door sometimes needs to be held open so a suitable magnetic device should be fitted to maintain fire safety.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stroud Green Lodge 49 Stroud Green Way Addiscombe Croydon Surrey CR0 7BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michael Williams     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Stroud Green Lodge 49 Stroud Green Way Addiscombe Croydon Surrey CR0 7BE 02086541339 02086549715 garmit.wright@croydon.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: London Borough of Croydon care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: A variation has been granted to allow one specified service user under the age of 65 to be accommodated. The variation remains in force until such time as the needs of the service user can no longer be met or until such time as the placement ceases. Existing specified service users who are not in the DE(E) category may remain at Stroud Green Lodge whilst their needs can still be met and they choose to remain. Date of last inspection Brief description of the care home Stroud Green Lodge is a registered care home and is owned by the London Borough of Croydon [LBC]. It provides personal, but not nursing, care for up to 27 service users. The homes registration is in transition; in future the home intends providing care for people over 65 years of age who have dementia. A condition of registration is that the few existing service users who do not have dementia may remain in the home if they wish to do so, providing the home can continue to meet their needs. The home is situated to the East of Croydon and is close to public transport. Accommodation comprises 25 single and 1 shared bedroom. None has ensuite facilities but each has a wash-hand-basin. There are communal areas, lounges and/or dining rooms, on each of the three floors. The managing organisation, the LBC, was considering proposals that Care Homes for Older People Page 4 of 26 Over 65 27 0 Brief description of the care home would mean the early closure of this home as a part of the plan to build new facilities on other sites but at the time of reporting the Local Authority has revised its plans. Inevitably, relatives and the many other people who represent the service users were very disappointed by the uncertainty, and possibility of early closure. The temporary reprieve, estimated to be until 2008, will be welcomed by the many people who like Stroud Green Lodge as it is. The Commission does not seek to influence decisions about the opening and closing of care home but does expect standards to be maintained throughout the life of a home. Fees are currently from #517 per week. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We visited this service on 4th November 2008. Whilst the Local Authoritys plans for its early closure of this home have not been brought forward as expected, the long term plan is still to replace old care homes with new ones and this is still in progress. For this reason the residents of Addington Heights transferred to Stroud Green Lodge, referred to as Stroud in this report, along with their staff team and all the documentation and equipment needed to meet their needs. Since we very recently inspected Addington Heights and found it was achieving good standards this visit was limited to confirming that the transition had gone smoothly and residents were settling into their temporary accommodation. Where standards of staffing, care and administration remain as they were in Addington then those findings will be restated. Similarly where good standards relevant to Stroud itself were previously meet we Care Homes for Older People Page 6 of 26 confirmed that there was no evidence to indicate a deterioration in services and those findings are also restated. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Care Homes for Older People Page 9 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is 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. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the service user or, in some cases, their representative so residents know that their needs have been fully assessed and can be met in this home. Evidence: We are advised that there have been no changes to the manner in which standard 3 is being met this standard is based upon the visit we made in 2007 when we checked a sample of five of the residents the case files, we met with staff, with residents and their relatives. It is clear that the pre-admission assessments, usually provided by a care manager in the form of a comprehensive assessment, include general information about each service user, details of their background medical and social history and details of specific issues such as mobility, nutrition, diabetes, continence, medication and so forth. Each resident we checked had a contract and a copy of the homes Care Homes for Older People Page 11 of 26 Evidence: Service User Guide in their bedroom. There no matters requiring improvement to meet this standard so this section, about choice of home and the admission processes, is assessed as good. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All service users now have care plans setting out their needs and all have access to medical and health services. Good medication procedures are safeguarding residents and so residents feel well cared for staff and that are treating them with respect and dignity. Evidence: Residents have access to health care services both within the home and in the local community. Residents are able to choose their a General Practitioner, though most use a local practice, and attend local dentists, opticians and other community services. Residents unable to access local services are managed by visits to the home by health care professionals. Health needs are monitored and appropriate action and intervention taken. The home is able to provide the aids and equipment recommended. In our previous report we required improvement to infection control training and procedures and with the outbreak and Diarrhoea and Vomiting earlier in the year the home was commended for how well it managed the problem, noting that a local hospital was the source of the outbreak not the care home. Care Homes for Older People Page 13 of 26 Evidence: There is evidence in the Care Plan of health care treatment and intervention, and a record of general health care information. Staff encourage individuals to be independent and to take responsibility for their own personal hygiene. The views of residents are sought in the way personal care is delivered. Residents confirmed that staff negotiate with them as to how care, in particular personal care is be offered and, in respect of diversity, the home can now offer a choice of male or female carers. Staff have also arranged for a voluntary translation service and other methods, such as picture cards to act as prompts and we are told this has been very successful for client whose do not have a good grasp of spoken English. The home has a medication policy which is accessible to staff, medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. Staff have introduced a better system for checking medication, that is not in dossette box. The home understands the need to comply with the administration, safekeeping and disposal of controlled drugs, but no control drugs were being used at the time of my visit to this service. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care. Areas of strength include residents comments that staff are kind and caring and the documentation supports this, one residents told us in her written reply the home is, very compatible. This section, about health and social care is assessed as good. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users feel that they have the lifestyle they would wish for and expected in Addington Heights. Residents do keep in touch with family and friends as they choose and residents say the food in this care home is very good. Evidence: Staff now seem more aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. We said last year that some residents are consulted or listened to regarding the choice of daily activity, but this process could be improved. For example one resident, in their written comments to the Commission last year, said they would like more activities, another said they would like to go out more and this was in their review notes but not translated into a care plan. The manager advises us that all care plans have been checked and updated so as to address this point. The extra space and use of the ground floor facilities gives greater opportunities for activities and combined with more entertainers and more trips this standard is now more fully met. In respect of diversity, the home admitted a resident who does not speak English and only one member of staff, who has since left, had some understanding of her language. Since last year the home has worked with the local care manager to improve communication Care Homes for Older People Page 15 of 26 Evidence: with the resident including g picture cards and volunteer visits to assist in communication. The food in the home is of satisfactory quality, well presented and meets the dietary needs of residents. The home scored highly in recent hygiene check and scored 4 stars, a silver award, for catering in the home for which they received certificate from the Mayor of Croydon. Very commendable. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. I met with the cook and was impressed with the effort she makes to get to know residents and their food preferences. The cook makes a special effort to create special meals such as oriental food for a new resident, she met with relatives to develop a range of meals to suit the residents expectation and this approach is commended. However, there appears to be little opportunity for residents to be involved in food shopping, the preparation of meals and menu planning despite the homely layout of the units, which would lend itself to greater resident independence in this area of their lives, despite this shortcoming a resident who wrote to us specifically identified the meals as something she enjoyed and said, the food is nice here. Areas of strength include the generally relaxed atmosphere in the group units; the comments of residents who say they like living in Addington Heights and the good food all indicate customer satisfaction. This section, about daily life in Addington Heights, is assessed as good. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: 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 care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 has a clear and simple procedure, posted on the noticeboard of each lounge, for dealing with complaints, so service users are confident their concerns will be dealt with promptly and effectively. To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property; this includes procedures for passing on concerns to the relevant authorities including the Commission. Evidence: The home has an open culture that allows residents to express their views, and concerns in a safe and understanding environment. Residents and others involved with the service say that they are happy with the service provision, feel safe and well supported by an organisation that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand. I checked the record of complaints is in place. No complaints were made by residents, or their relatives, during the course of this inspection although some suggestions were made and passed on to staff. Like many procedures used in this home the complaints procedures are those used by the local authority, L B Croydon, who can make its procedures available in alternate formats and languages if the need arises. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within Addington Heights including the reception area. Residents told me that they know how to make a complaint and are clear about what will happen if a Care Homes for Older People Page 17 of 26 Evidence: complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. The home understands the procedures for Safeguarding Adults and will always attend meetings or provide information to external agencies when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The outcomes from any referral are managed well and issues resolved to the satisfaction of all involved. Training of staff in the area of protection is regularly arranged by the Home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. Areas of strength are the local authoritys complaints procedures and the wide circulation of information about this, also very positive is the prompt referral of issues to the local authority complaints or safeguarding procedures when necessary. As no matters requiring improvement were identified in this area, about complaints and protection, this section is assessed as good. Care Homes for Older People Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 layout of the home and the manner in which it is being maintained means that this is a clean, safe, comfortable and suitable environment for the service users. Evidence: The home was in a reasonable state of decoration, minor damage to paintwork was noted but in general it is a nice home, large and a little old-fashioned but nevertheless service users and relatives appear to be happy with the premises. No hazards were identified during the inspection and the accident record shows few accidents have occurred in the previous three months indication this is a safe environment for service users. It remains the case that the owners, the local authority, intend replacing their older care homes including Stroud Green Lodge, which do not meet modern standards, with premises that will meet service users needs in greater comfort and provide improved personal accommodation. Areas of strength are homeliness achieved in this large old building and the bright open atmosphere of the place - and no matters requiring improvement are noted - so this section, about the accommodation, is assessed as good. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 number of staff employed, their recruitment and their skill mix are appropriate to the assessed needs of the current residents in this home, so this ensures their needs are being met. Evidence: Residents are satisfied that the care they receive continues to meet their needs, although last year residents commented upon the fact that they sometimes have to wait for assistance and sometimes staff were not free to support activity programmes. Despite these obvious shortcomings, inherent in group living situations where staff are dispersed into each unit, the residents described staff as excellent and brilliant. When asked if they provide the care they need residents wrote, very much so. Similar comments were received again this year, in addition to commending the food residents also said of the home is very good, that it is run properly by staff, and the management is excellent. Staff are therefore to be commended for their good work. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. We checked the new training manual which very quickly and readily identifies who has had what training and what is being planned and full programme of training is in place. The staff we spoke to were well qualified including National Vocational Qualification to level 3. Staff meetings and individual staff supervision has now been reinstated so this Care Homes for Older People Page 20 of 26 Evidence: section about staffing re-assed as good. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 manager, having moved from Addington to Stroud will need to register again with the Commission but was previously registered with us and was found to be a person competent to run this home in accordance with its stated aims and objectives and so in the best interests of the service users. Evidence: The manager who moved with the residents to Stroud is qualified and has the necessary experience to run the Stroud. He is aware of and works to the basic processes set out in the Standards although his staff team were unable to locate a copy of the standards when I visited them in the Addington service. The manager is aware of the need to keep up to date with practice and continuously develop management skills. The service is planned to be resident focused, to take account of equality and diversity issues, and generally works in partnership with families of residents and professionals. The manager and his senior managers are aware of the need to promote safeguarding and they have in place health and safety policies that Care Homes for Older People Page 22 of 26 Evidence: generally meets health and safety requirements and legislation. The service provider, L B Croydon, rather than the manager of the home, takes responsibility for the homes accounts and business development and so during the course of the inspection it was not possible to establish why staff felt that there was insufficient support for their training requests, staff assume it to be a lack of funding and the fact that the home is to close before very long. During this revisit to the staff team now in Stroud we identified that a new supervision system is in place and this includes assessment of training needs and we are advised that where staff training needs are identified training will where possible put in place. Areas of strength include the qualifications and experience of the manager, the residents think highly of the staff and like this home, records, policies and procedures are general sound. This section, about management and administration is assessed as good but a recommendation is made for the providers to apply for the registration of a manger. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 31 Manager, it is recommended that the providers, L B Croydon apply for the registration of a manager for this home. This is so that the residents will know that the the service is being run by somebody assessed as safe and comeptent to do so. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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