Inspection on 19/04/06 for The Lodge

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 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

The Lodge 18/08/09

The Lodge 02/12/08

The Lodge 09/01/08

The Lodge 11/04/07

The Lodge 05/07/05

The Lodge 28/04/05

The Lodge 04/10/04

The Lodge 17/05/04

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

CARE HOMES FOR OLDER PEOPLE The Lodge Watton Road Ashill Thetford Norfolk IP25 7AQ Lead Inspector Mr Christopher Handley Unannounced Inspection 19th April 2006 09:30 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 The Lodge DS0000027322.V290791.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. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Lodge Address Watton Road Ashill Thetford Norfolk IP25 7AQ 01760 440433 01760 440043 kaz1509@hotmail.com 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) Mr Kenneth John Squire Mrs Irene Margaret Squire Mrs Karen Syer Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th July 2005 Brief Description of the Service: The Lodge is a residential home registered for 20 elderly people. The home was originally a large detached family home, and it retains many of its original features. There is a large lawn at the front of the home which provides a good sitting area for residents, with smaller gardens at the side and rear. There is a car park at the front of the home. If nursing care is required it is provided by members of the District Nursing team. Any medical or specialist services are obtained via the GP. The home is situated on the outskirts of the village of Ashill, on the Swaffham to Watton Road (B1077). The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 6.5 hours. Preparatory work had been undertaken beforehand. Five Comment Cards from residents/relatives had been received. On the day of the inspection there were 17 residents in the home. As part of the inspection 2 visitors, 4 residents,4 staff, the Manager and Proprietors were interviewed by the Inspector and a full tour of the home was undertaken A wide range of records, files, polices and care plans were examined. A total of 20 standard were inspected. What the service does well: What has improved since the last inspection? Areas of the down stairs corridor have been improved. The process of assessing those residents who have dementia has started and the manager has created two groups of people according to their presenting needs so that care can be more focussed. Early indications are that about 9 people have advanced dementia type illnesses. The Manager has also spoken to relatives about the separation process and the potential change to an all dementia registration and they are accepting of this process. Further discussions between the Manager and residents and relatives will take place. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 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. The Lodge DS0000027322.V290791.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 The Lodge DS0000027322.V290791.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): 3&6 Quality in this outcome area is good. All residents have a pre-admission assessment. This home does not admit prospective residents for intermediate care. EVIDENCE: All residents have a detailed preadmission assessment carried out by the Manager prior to admission to the home. This process ensures that the home can meet the assessed needs of prospective residents to the home. The assessment document is comprehensive and detailed, and covers physical mental health and social needs. These documents are neatly completed and kept in the residents individual file. Four of these documents were read by the Inspector. This home does not admit residents need intermediate care. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 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, & 10 Quality in this outcome area is good. All residents do have an individual care plan. The resident’s health care needs are met by the staff of the home and a wide range of health care workers. The medication service provided to the residents is safe and effective. Residents are treated with respect, and their right to privacy is upheld. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 10 EVIDENCE: All residents have an individual care plans which is kept in an A4 ring binder folder, four of which were read by the Inspector. The care plans have the essential elements of care planning, namely assessment, plan, implementation and review. The assessment area covers the physical, mental, and social well being of the residents. Residents and relatives are involved in reviews of care, There is also a wide range of other documentation including risk assessment, a Daily record, visits by medical staff. The notes are set out clearly, and are kept secure in a named A4 folder, in order to preserve the confidentiality of the contents. Ways in which the care plans could be developed for people with a dementia type illness were discussed later with the manager of the home. They must include a full social history and activities should be included as part of the weekly plan and signed off by members of staff. In this way it ensures that stimulation is offered to everyone on a regular basis. The health care needs of all residents are carefully monitored on an ongoing basis. All residents have a G.P. The health care needs of the residents are met by the staff of the home or by visiting health professionals. If needed the G.P. would refer a residents to a consultant. In the inspection dated 5/7/05 it was recommended that the Manager seek the opinion of the GP’s and others in relation to some of the residents who appear to be in the early stages of dementia. This has now happened and the GP’s consider that all of the residents currently accommodated in the home have some degree of dementia with 9 in the more advanced stages. The Manager has spoken to the relatives about a possible change in registration and they appreciate the need for change. Others matters, e.g. training will also need to be addressed, in order to provide the proper care for the residents. The four residents with whom the Inspector spoke, said that if they were not well, staff would get the Doctor to come and see them, or the nurse, which ever was needed. Staff interviewed were aware of these arrangements. The Manager said that the home enjoys a good relationship with the supporting health colleagues. The residents’ medicines are kept in a locked cupboard, in a designated locked room. Staff who administer medicines are trained to do so. The home has a Medidose system of medicines which works well in the home. The record of administration of medicines which was seen by the Inspector it is neatly maintained. There are no residents in this home who self medicate. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 11 The home does handle Controlled Drugs, one of which was counted by the Inspector, and found to be correct. These drugs are kept in a designated Controlled Drugs Cabinet and the records maintained in the appropriate book. The home has a detailed and comprehensive procedure for the reception, storage, administration, and disposal of medicines, which was seen by the Inspector. If staff had any concerns about the effects of medicine on residents they would contact the prescribing G.P. The home enjoys a good working relationship with the supplying pharmacist. In the report dated 5/6/05 it was stated that the medicine room is to be upgraded, as yet this work has not been done, but it is still on the work schedule, the Manager said. Privacy and dignity form part of the induction of staff and during this period new staff work with more experienced staff, the Manager said. Staff are aware of the importance of maintaining resident’s privacy and dignity based on discussions with them. The residents spoke well of the staff attitude to this aspect of their care, “Doors are always closed”,” I’m always properly dressed”. “I’m always called by my proper name”. The comments cards confirm that people feel they can see their visitors in private should they so wish. Residents wear their own clothes, and they all appeared neat and tidy. Residents have access to a phone. Any form of examination or private discussion would take place in the privacy of the residents own room. Double rooms have privacy curtains. The Lodge DS0000027322.V290791.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): 12,13,14,15 Quality in this outcome area is good. There is a wide range of choice provided to residents in their daily lives. Residents do maintain their contact with relatives. Residents are helped by staff to exercise control over their lives., their style of dress and hair. Residents do receive a wholesome and nutritious diet. EVIDENCE: Friends and visitors are welcome to visit the home at most reasonable times, but are asked to avoid meal time if at all possible. Two visitors came to the home on the morning of the inspection and confirmed as did the comment cards that they are welcomed in the home and can see people in private should they so wish. Visitors from the local church visit the home on a regular basis. The comment cards received show that visitors are welcome to the home. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 13 Residents have as much choice as is possible within the bounds of their safety. They can choose when they go to bed, choose to lie in if they want, or when they have a bath. Where possible they choose their own clothes and their own hairstyle, and when they have their hair done. During the afternoon there are a range of activities provided including Bingo Art and Crafts, Singing, Games and Quizzes. These are advertised on the board so that all will be aware of them. Some residents just prefer to sit quietly in their room and read either the paper or a book. Many residents have brought personal items from their own home and the four interviewed by the Inspector spoke very fondly of some of the items in their rooms, which included ornaments and photographs. The Manager informed the Inspector that there are no residents who handle their own money, but this is dealt with by relatives. If relatives needed advocacy, the Manager would provide them with a sources of advice. The comment cards show that the residents like the meals provided. The four residents interviewed said that “they were very nice”, “always enough”, “I can change my mind if I want”, they are always hot”. Two visitors who spoke to the Inspector said that in their opinion the meals were good. The menus seen appear interesting varied and nutritious. Special diets e. g Diabetic diets are provided. The individual choices and preferences of residents are well known to the cook who ensures that residents get the meals which they like. The Cook, Mrs Squire is very much aware of the importance of food and the Inspector saw her talking to a resident in the corridor explaining to her what was for dinner. Her practice is that she asks residents their choice for lunch. Drinks are provided for residents during the day and the Inspector saw this in action during the inspection. The Lodge DS0000027322.V290791.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 Quality in this outcome area is good. The home has a complaints procedure in place. Staff have had training in the Prevention of Adult Abuse. EVIDENCE: The complaint procedure is prominently displayed in the front hall, and was seen there by the Inspector. The Comment cards show that people are aware of the complaints process. Residents interviewed are aware that there is a complaint procedure, but they told the Inspector if they had a concern they would see the Manager, who believes in dealing with concerns quickly. Staff are aware of the homes complaint procedure. There have been no complaints since the last inspection. The home has an Adult Abuse Protection Procedure which was seen, and staff interviewed are aware of the home’s policy. Staff have had training in the Prevention of Adult Abuse. The Lodge DS0000027322.V290791.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 & 26 Quality in this outcome area is adequate. There is upgrading work taking place at present which means the home is not currently as well presented as is normally the case. The premises are clean and hygienic. EVIDENCE: The home is suitably located for the existing registration, but care needs to be taken to create a safe access to the outside as and when the registration is changed. There are daffodils in full bloom at the front of the home. To improve the appearance of the front of the home the Proprietor may wish to redecorate the front door and repair the front drive, which would further improve the appearance of the front of the home. The home meets the requirements of the local Fire Service and the Environmental Health Department. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 16 The major renovation work being carried out on the ground floor has made good progress, but there is still work to be done and the Proprietor is urged to complete this as soon as possible. This work consists of replacing a toilet and hand basin, associated tiling and renewing the corridor floor. Whilst this work has been carried out, the safety of residents has been uppermost, and must continue to be so. The residents rooms are of a high standard and the Inspector inspected seven of them . They were all neat and tidy and odour free. The rooms have been personalised by the residents, and there are a good deal of ornaments and pictures. The residents were interviewed their rooms. They were very pleased with them saying that they were “very comfortable”, that “staff kept them tidy”, and that they were “very fond of their rooms”. Double rooms have privacy curtains. The upstairs windows have had safety bars fitted. The home was clean, hygienic, and odour free. At present there are a number of residents who are mentally frail, and prior to the home undergoing a variation to the registration, changes to the environment will be needed, and discussions on this matter have already started. It is important to provide a meaningful choice of association for people who have varying degrees of mental ability. The management of the home need to ensure that there is sufficient communal space to meet need and there may need to be two sittings of dinner to ensure that this is an unhurried and pleasant affair. The manager is aware that certain areas of the home are beginning to need refurbishment. The home has a laundry which is sited in a location that soiled clothing is not carried through areas where there is food. There are hand washing facilities in place. The laundry floor is impermeable. There are procedure for the control of infection, the safe handling and disposal of clinical waste, the provision of protective clothing and hand washing. Washing powders and cleaning liquids are kept locked. The washing machine has specified programme to meet disinfection standards. The Lodge DS0000027322.V290791.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 Quality in this Outcome area is adequate. There are adequate numbers of staff on duty at to meet the residents needs present. The recruitment practice in the home is good. A wide range of training has been undertaken by staff but the standard is not fully met as the number of NVQ staff needs to be increased. EVIDENCE: The duty rota is very clearly printed out. At the time of the inspection there were two Care Assistants, one domestic, one cook,(the Proprietor) one assistant cook, one manager and one handyman (the Proprietor) on duty. The level of residents dependency is closely monitored by the Manager who is aware that when the registration category is changed, the staff must be increased to reflect greater resident dependency. At present there are no staff who have NVQ 2 only. There are two members of staff who have NVQ 3. The Manager is aware of the need to increase the number of staff who have this training to a required minimum ratio of 50 , and she and the Proprietors are advised to encourage and support staff to undertake this training. In the report dated 2 July a recommendation was made concerning this matter, the Inspector now makes this a requirement. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 18 The home’s recruitment procedure was examined. Four staff files were scrutinised. Written references are obtained. Police and POVA checks are carried out. Interviews are conducted by two people. Job descriptions and contracts are supplied. Members of staff are given copies of the Code of Practice. The home has traditionally had a very low turn over of staff the Manager said. The home has an Induction and Foundation training programme, Mulberry House which was seen by the Inspector. The training provided includes First Aid, Health and Safety, Manual Handling, Food Hygiene, Fire Safety, COSH Awareness , Promoting Continence, Training in Adult Abuse Prevention, Boots Medication Training. This information is kept in the member of staff’s file As part of the variation in registration there will be a need to provided staff with training for caring with people with dementia, and the Manager is collecting information on this matter. She will also need to ensure that she has an enhanced level of understanding of dementia type illnesses. The Lodge DS0000027322.V290791.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): 31,33,35,& 38 There is a competent and experienced Manager in post. The home now has a Quality Assurance system in place. The home does not handle residents’ finances. The home is developing good practice in health and safety. Quality in this Outcome area is good. The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 20 EVIDENCE: Mrs Syer is the registered Manager of this home, she has been in post for eight years, she has her D325/2 and 325/3. She is clearly the leader of the team. She is competent and experienced to run the home. She undertakes periodic training. She and the senior staff are familiar with the diseases associated with old age. She has a detailed job description which has been seen previously by the Inspector. As part of the variation in registration the Manager will have to undertake training in care for people who have Dementia The residents interviewed spoke highly of the Manager. When the last inspection took place the home was in the process of developing Quality Assurance. The home now has the Mullbery Organisation System in place and the Inspector saw some of the documentation. The Manager explained how the system worked. Questionnaires are sent out and returned and comparisons are then made with the previous returns to see if the service, has improved or not. The outcomes of the survey must be shared with the service users and/or their relatives as well as the Commission. The outcomes should form a plan for development of the service. The good practice of the home is that they do not hold any monies on behalf of residents. The Manager will however facilitate advocacy, by advising relatives to contact organisations who will provided them with advice on these matters. Through training and development the Manager has raised the awareness of staff about the importance of Health and Safety practice in the home. The home has all the documentation required by Standard 38, it is kept neatly in files in the office and may be used by staff for elements of their studies. The Lodge DS0000027322.V290791.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 The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 22 CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 23 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 2 Standard OP28 OP19 Regulation 19,(5) (b) 23 (2) (a) Requirement It is required that the number of staff who have undertaken NVQ II be increased to 50 of staff It is required that an Action Plan for the Variation in Conditions is submitted to the Commission in line with the discussion which have taken place Timescale for action 01/04/07 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard Good Practice Recommendations The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI The Lodge DS0000027322.V290791.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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