CARE HOMES FOR OLDER PEOPLE
The Lodge Copdock Ipswich Suffolk IP8 3JD Lead Inspector
Mike Usher Unannounced Inspection 16th February 2006 3:15 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 DS0000024437.V284152.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000024437.V284152.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Lodge Address Copdock Ipswich Suffolk IP8 3JD 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) 01473 730245 01473 730245 Gemini Care Limited Mr Michael Bailey Care Home 44 Category(ies) of Dementia - over 65 years of age (44) registration, with number of places DS0000024437.V284152.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 6th October 2005 Brief Description of the Service: There has been a residential home caring for older people in the present building for many years. The current owner, Gemini Care Homes Ltd (a company owned wholly by Mr Abbas), was registered in December 1997. The Home is a large country house set in its own mature gardens, situated on the main road running through the village of Copdock. The County Town of Ipswich is a few miles to the north and the home is near to the main A12 road from London. The current owner carried out an extensive refurbishment of the accommodation in 1998, and in late 2005 completed two new ground floor wings providing spacious accommodation to a very high standard. At the same time a further refurbishment, and expansion of the communal areas was carried out, with more separate communal areas being created, and at the same time reducing the number of shared bedrooms. The home now caters for 44 residents, and specialises in caring for older people with dementia. A person-centred philosophy of care is being developed, and this is reflected in improved staffing levels, and specialist nature of the staff training programme, and the organisation of care, and the layout of the accommodation. DS0000024437.V284152.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection focused on previous requirements and recommendations, significant developments, and core standards not examined at the previous inspection. A variety of methods were used, including observation, discussion with managers, staff, service users and visitors, and examination of records and other documentation. Although the home has recently undergone a major expansion, the standard of care has been maintained at a high level. The staff and management are to be congratulated on achieving such a good level of service, although on this occasion it was let down by significant lapses in essential records and documentation. What the service does well: What has improved since the last inspection?
The home has just completed the building of two new accommodation wings, proving an extra 19 single bedrooms. These rooms are well sized and well designed for the needs of older people, incorporating such features as underfloor heating, low window sills for improved views, and all having en suite WC’s. The new accommodation also includes assisted baths and showers, and the communal areas have been significantly expanded and improved. There are now a number of different communal areas within the home, offering more choice and variety for service users. The number of shared bedrooms has been reduced in favour of more single rooms, and to provide more communal space. DS0000024437.V284152.R01.S.doc Version 5.1 Page 6 All the new and refurbished accommodation has been finished to a very high standard. The management structure has been strengthened and the increase in service users accommodated (from 29 to a maximum of 44) has been accompanied by a corresponding increase in the staffing levels. Basic training for staff now includes more specialist subjects, such as caring for people with dementia, and nutritional needs. 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. DS0000024437.V284152.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000024437.V284152.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 The home has informative documents for prospective service users. The assessment process is adequate in practice, but the standard of recording is poor. EVIDENCE: Most service users are referred by Social Care Services (SCS), and have therefore already undergone an assessment of their needs. This assessment is usually included in the documentation in residents’ care plans, but the home carries out a separate assessment to ensure that the home can fully meet the needs of the individual, and to gather further information necessary for the care plan. The manager and care manager described the assessment process they use, which is clearly effective as they were able to give examples where the assessment did not allow admission, as well as those where it was in agreement with the SCS assessment. Unfortunately these assessments are not documented. DS0000024437.V284152.R01.S.doc Version 5.1 Page 9 New versions of the Statement of Purpose and Service User Guide have been produced recently to reflect the expansion of the home. The home does not provide intermediate care. Therefore, Standard 6 is not applicable. DS0000024437.V284152.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Care plans for recently admitted residents are inadequate, although the overall process is satisfactory. Medication arrangements need to be improved to ensure accuracy of administration. EVIDENCE: The new care planning system is in place but needs further development. In a number of samples inspected (focusing on service users admitted in the previous two months) large sections of the care plan were blank, or had minimal information. Photos, assessments and short-term plans were often missing, and where they were present, were often not signed or dated, and with little evidence of them being reviewed. Care plans relating to residents admitted more than one year ago were much more detailed, with a good amount of information, detailed assessments and care plans, and evidence of an effective review process, and key worker system in place. Health care needs are well documented and recorded. The arrangements for the storage and administration of medication were examined. Medication is stored in locked cupboards and trolleys, within a locked room, which is used only for that purpose.
DS0000024437.V284152.R01.S.doc Version 5.1 Page 11 This is satisfactory, although it is doubtful that it is adequate for controlled drugs, as these usually have to be stored in a locked metal cupboard. Records were generally in good order, but it was noted that some confusion arises when the blister packs used are not all started on the same day, and records did not always accurately record the doses given (or missed). The use of different codes has been clarified and is being used consistently, but would benefit from comparison with a list of staff names and signatures. There is now an internal audit system where staff on night and day duties checks each other’s entries. However, there were some missing entries, so this system still requires further development. Relations between staff and residents were observed to be warm and supportive. Staff were seen to treat residents in a friendly manner, but also with respect, avoiding any patronising behaviour. DS0000024437.V284152.R01.S.doc Version 5.1 Page 12 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, 15 The home continues to develop appropriate activities and help service users maintain contact with their families. Improvements have been made to the catering, to more appropriately provide for people with dementia. EVIDENCE: At the time of the inspection most of the residents were in the newly extended lounge, where some were participating in a large floor game, helped by two carers, whilst others sat and watched or were joining in a sing-along. A number of visitors were present during the inspection, with family and friends spending time with residents in the lounge and also in more secluded areas. A new 4-week menu has now been produced, and records seen confirmed a good variety, as well as individual variations. The management have given much consideration to improving the catering, with specific consideration to the needs of people with dementia. Staff have recently undertaken training in nutrition, in conjunction with the Ipswich Hospital, using the Malnutrition Universal Screening Tool. Associated procedures and processes were displayed on staff notice boards. DS0000024437.V284152.R01.S.doc Version 5.1 Page 13 Routines in the mornings have been revised to provide 2 sittings for breakfast, which allows staff more time to assist very dependent service users, whilst letting those more able to go at their own pace. DS0000024437.V284152.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Service users are safeguarded, but the service would benefit from improved training in Protection of Vulnerable Adults (POVA) procedures. EVIDENCE: A good staff training programme is in place, but the management would benefit from a member completing the SCS POVA training course, which can then be cascaded down to other staff, as this aspect needs to be incorporated into staff training. The manager confirmed that there have been no complaints since the last inspection was undertaken, and the Commission has received none. This underlines the continued improvement the service has made in recent years, which now provides a safe and supportive environment for service users. DS0000024437.V284152.R01.S.doc Version 5.1 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, 20, 21, 22, 23, 24, 25, 26 The accommodation has been much improved in recent months and finished to a very good standard. EVIDENCE: At the time of the unannounced inspection, the home was clean, tidy, warm and comfortable, with no odour. There was a relaxed and calm atmosphere, with plenty of energy and activity apparent. The new accommodation is now completed and in use. Two new bedroom wings have been built, with individual rooms being very well sized, with en suite WC’s and under-floor heating throughout (individually controlled in bedrooms). The use of under-floor heating ensures that there is no risk from exposed hot surfaces, and also provides a more comfortable, uniform warmth, with no cold spots. It is especially helpful to older people, ensuring that there is always warmth around their feet, and also being safer for any resident should they fall, helping to prevent hypothermia. DS0000024437.V284152.R01.S.doc Version 5.1 Page 16 New bedrooms also feature low-level windows, providing residents with a pleasant view when seated. Windows have been fitted with restrictors for safety. A ‘quiet’ lounge has been created from the former dining room, as an alternative sitting area to the main lounge, and two large ground floor bedrooms at the front of the building have been converted into dining rooms. New assisted bathrooms and shower rooms have been included in the new accommodation, which has all been finished to a very high standard. The grounds are still to be completed, but will provide a safe and secure area for residents, as well as better parking for staff and visitors. DS0000024437.V284152.R01.S.doc Version 5.1 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, 28, 29, 30 The home is well staffed, with carers being competent and well trained. EVIDENCE: At the time of the inspection, there were 6 carers on duty supported by the manager and care manager. The staff rota confirmed that this was the planned level of staffing, with the current number of service users being 41. This level is the normal level of staffing and is maintained throughout the day, with 4 carers on duty at night. The management has recently been strengthened by the appointment of a Night Manager, in recognition that, as service users are sometimes active during the night, then the delivery of care is planned on a 24-hour basis. This is an exemplary development, ensuring that care and attention for service users is properly available at all times. The home has been experiencing difficulties meeting previous requirements to obtain POVA first checks for all new staff before employment, due to the particular problems with staff recruited from abroad. Whilst this remains a requirement, the Commission agreed to review the matter internally to enable a consistent approach to be taken, and will provide additional advice under separate cover. In all other respects the recruitment process is satisfactory. The employment of care staff from abroad has been successful, and care is taken to ensure that all staff have adequate English language skills, and the home has also assisted in arranging for tuition to be offered to those needing more help.
DS0000024437.V284152.R01.S.doc Version 5.1 Page 18 A staff training programme is in place, and recent training has been provided on dementia care and nutritional needs of people with dementia. Further training in protection issues would be beneficial (see section on Protection). DS0000024437.V284152.R01.S.doc Version 5.1 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): 31, 32, 33, 37, 38 The home is well managed, to the benefit of service users, with good standards of documentation, although the standard of recording is poor in places. EVIDENCE: The management structure has been strengthened, and the Manager is now supported by a Care Manager, Night Manager, and two Assistant Care Managers, plus a number of Senior Carers. Mr Bailey recently finished as a runner-up in a prestigious trade industry ‘Manager of the Year’ competition. This reflects the very creditable improvements the home has made since his appointment. The development of person-centred care in the home continues, and the improvement in the care practice, staff training, and the environment (detailed elsewhere) all provide evidence and confirmation that the home’s philosophy of care is being put into practice. This ensures that the home is run in the best interests of the service users.
DS0000024437.V284152.R01.S.doc Version 5.1 Page 20 The new Statement of Purpose and Service User Guide reflect this culture of care, and inform the other policies and procedures, ensuring that they are appropriate and well maintained. Records are generally in good order, but with significant lapses (identified in earlier sections), and the recent building works have been completed to the satisfaction of the relevant authorities. DS0000024437.V284152.R01.S.doc Version 5.1 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 3 X 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X 2 3 DS0000024437.V284152.R01.S.doc Version 5.1 Page 22 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 OP29 Regulation 19 Requirement All staff employed in the home must be in receipt of a satisfactory POVA first check before they can be employed. The Commission is currently reviewing this requirement and further advice will be provided. The assessment process undertaken by the home must be adequately recorded. Adequate care plans must be in place for all new admissions, properly recorded, reviewed and updated as necessary. Controlled drugs must be stored in a metal cabinet, in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973. The system for the administration and recording of medication must be clear and accurate at all times. Management and staff must receive appropriate training in POVA procedures. Timescale for action 16/02/06 2 3 OP37OP3 OP37OP7 14, 17 15, 17 16/02/06 16/02/06 4 OP9 13 16/03/06 5 OP37OP9 13, 17 16/02/06 6 OP18 13 16/05/06 DS0000024437.V284152.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000024437.V284152.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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