Inspection on 02/12/08 for The Lodge

This inspection was carried out on 2nd December 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Lodge 18/08/09

The Lodge 09/01/08

The Lodge 11/04/07

The Lodge 19/04/06

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 06/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Lodge Watton Road Ashill Thetford Norfolk IP25 7AQ     The quality rating for this care home is:   one star adequate 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: Kim Patience     Date: 0 2 1 2 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 24 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 24 Information about the care home Name of care home: Address: The Lodge Watton Road Ashill Thetford Norfolk IP25 7AQ 01760440433 01760440043 kaz1509@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Syer Type of registration: Number of places registered: Mrs Irene Margaret Squire,Mr Kenneth John Squire care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Date of last inspection Brief description of the care home The Lodge is a residential home registered for 20 elderly people with Dementia. 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 fees charged at this home range from £393.00 - £450.00 per week. 0 Over 65 20 Care Homes for Older People Page 4 of 24 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: one star adequate 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: This inspection takes into account all the information recieved by the Commission since the last key inspection. We also conducted an unannounced visit to the home, which took approximately 6 hours to complete. During the visit we looked at records relating to residents, staff and the running of the business. We also spoke with residents, relatives and staff and made observations of daily life in the home. Care Homes for Older People Page 5 of 24 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 6 of 24 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 7 of 24 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. People making a decision to move into the home can be assured they will be given information about the service so they can assess whether it is suitable to meet their needs. In addition the home carries out a needs assessment so they can confirm they have the capacity to meet the persons needs. Evidence: The home has policies and procedures for the admission of new residents. We looked at the records relating to one resident recently admitted and found the home had carried out a pre admission assessment prior to the person moving in. Care plans had been written and showed sufficient information about the persons needs. We spoke with the resident who confirmed they had visited the home before moving in and liked it. The manager had completed a needs assessment and provided information about the service offered. The person was also able to bring in some personal items and furniture to make their private accommodation more homely. Care Homes for Older People Page 8 of 24 Care Homes for Older People Page 9 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can now be assured their health and care needs will be assessed and met. The service takes peoples changing needs into account and provides appropriate care and support. Medication management practices now safeguard peoples health and welfare. Evidence: We looked at the care records relating to 3 people in the home and made observations of their daily life to see if the care records accurately reflected their needs. We also spoke with residents, relatives and staff. Improvements have been made to care plans and associated records. There is now fairly detailed information about individuals and their needs. Care plans were appropriately written and contained most of the relevant information. Health care assessments and risk assessments were also found in the records. These records were being reviewed monthly and there was evidence that where peoples needs had changed the records had been up dated. The home has also introduced mental capacity assessments in accordance with the Mental Capacity Act. Care Homes for Older People Page 10 of 24 Evidence: We spoke with one relative who told us that they visited the home every day and found the care to be of a good standard. They felt that staff were kind and friendly and their relatives needs were being met. Another resident said they received good support from staff and when they were unwell recently, staff were very attentive and provided good care. This person was very happy with the care provided. However, improvements to record keeping are still needed. For instance, it was unclear as to whether care plans were being reviewed monthly as the review and evaluation dates were not written on the individual care plans. We also found some omissions in care planning such as no care plan as to how a person should be supported when experiencing behavioural disturbances. In addition the home needs to make the care records more person centred and include information relating to individual lifestyle choices, such as how often people like to bathe and what their preferences are in respect of food and drink. Care Homes for Older People Page 11 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with social activities and choice in the way they wish to live their lives. However, daily life is not always based on peoples previous experiences and the home may not always provide an environment that promotes personal choice and autonomy. Evidence: As written in the health and personal care outcome area, care plans need to be more person centred to ensure that people are supported to live their life in a way that is consistent with previous experiences. Records examined showed some interests and hobbies along with some good life history information. The activities provided did not necessarily relate to peoples previous interests and the service could continue to develop activities in this way. However, staff have all received training in activities for people with dementia and have more understanding of meaningful activity. One lady was seen playing with a doll and she was calm and content. Others were seen watching TV and listening to music. We also saw positive one to one engagement between staff and residents. In general, the provision of activities has been increased. Outside entertainers are brought into the home and some art and craft work takes place. People who were able to communicate their views said that life in the home Care Homes for Older People Page 12 of 24 Evidence: suited them and they were happy with the activities provided. During the visit we observed that most of the residents were seated in one lounge. The other lounge was closed and we were told by the manager it was closed as it was to be recarpeted. There was no evidence of this on the day. We also noted that some areas of the building were not properly lit. For instance it was very dark in the upstairs corridors and this may mean these areas are univiting and people are not able to see sufficiently to orientate around the home freely. The service must be careful not to restrict peoples movements by these means. We observed the mealtime experience and people appeared to enjoy their meal. The dining room was nicely laid out for lunch with individual place settings. However, the dining room is in need of some redecoration to make it more attractive and homely. The manager said the room is to be redecorated in the near future. On the day of the visit the cook was on leave and the deputy manager was covering. People were given a choice of food and drink and those that needed support received it appropriately. After lunch staff were seen completing records of dietary intake and this shows they are aware of the need to monitor peoples nutritional intake. The residents we spoke with said they enjoyed the food and one relative said the food always appeared to be varied and of a good standard. Care Homes for Older People Page 13 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about how to make a complaint and how they can expect it to be dealt with. However, the information is not displayed around the home. People can be assured the home promotes the protection of vulnerable adults. Evidence: The home has a policy and procedure stating how they handle complaints. It is contained within the service users guide, which is given to all residents. On the day of the visit the complaints procedure was not being displayed in the entrance hall and the home was advised to find a way of doing so. The manager said the service has not received any complaints since the last inspection. However, a complaint was received by the Commission. The elements of the complaint were addressed during the inspection visit and the findings are incorporated in this report. There were no issues about adult protection and staff have received updated training in safeguarding this year. Care Homes for Older People Page 14 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers reasonably comfortable, homely accommodation. However, it is in need of some refurbishment and redecoration. In addition, signage and lighting must be improved so that people can orientate around the home freely. Evidence: We completed a tour of the premises and found that most areas were clean and tidy. We did not detect any unpleasent odours in the communal areas but we could detect odours in some of the bedrooms entered. The communal areas are homely and comfortable but the home in general needs some refurbishment and redecoration. For instance the dining room is now looking tired and worn. However, we were told by the manager that there is a plan of redecoration in place and some of the carpets are to be replaced. The home lacks good signage to assist people to orientate independently around the building. Some bedroom doors did not have a name on them and it would be difficult for someone with poor recall to find their room. Bedrooms were homely and comfortable with lots of personal items within. Some bedrooms were cold on entering and people would not necessarily find their room Care Homes for Older People Page 15 of 24 Evidence: warm and inviting. We spoke with one resident who was very happy with her room. There were lots of personal items in the room and they had been able to bring their own furniture when moving in. In addition, the home had placed a garden bench made by the persons son in the garden where it could be viewed from the bedroom window and the resident was very pleased with this. When entering peoples rooms we found that there were still some accessible toiletries that could be hazardous to people if misused. For instance, one room contained denture cleaning tablets. The communal bathrooms are also in need of some refurbishment to make them more homely and inviting. We were told by a member of staff that there is only one useable bathroom as it has an assisted bath. The home should have at least two bathrooms in use. We found that some areas of the home were dark as the lights had been turned off. This may restrict people from these areas as they would not necessarily be able to see where they were going. The home should be well lit throughout at all times. Care Homes for Older People Page 16 of 24 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care is deliverd by trained and competent staff. However, at times there may not be sufficient numbers of staff to meet peoples needs. In addition, new staff may not have all the pre employment checks in place. Evidence: We looked at the staffing levels in the home. On the day of inspection there were 16 people living in the home and 4 staff on duty. However, one of those members of staff was covering the kitchen as it was the cooks day off. During the inspection peoples needs appeared to be met. We spoke with one resident and one relative and both said the staffing was adequate. We looked at the staff rotas and found that on occasions the staffing levels fell to only two people on duty in the morning and three in the afternoon and this raises some question about how well peoples needs are being met at these times. The home employs a full time cook and domestic staff. We looked at the staff files relating to three people appointed since the last inspection and found some shortfalls in recrutiment practice. Files contained an application form, evidence of interview and identification. However, two of the three files did not contain Care Homes for Older People Page 17 of 24 Evidence: a POVA or CRB check and one did not contain references that the home had applied for. We looked at staff training and found that staff had been provided with induction training and all staff had been provided with mandatory training this year. In addition, staff had been provided with training in dementia awareness, challenging behaviours and activities. Care Homes for Older People Page 18 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced management team and there are systems in place for monitoring the quality of the service. However, improvement is still needed in areas such as recruitment and health and safety before this outcome area can be rated as good. Evidence: The home has a registered manager who has worked in the home for several years. The manager is currently undertaking advanced training in dementia studies. There is also a deputy manager and senior care staff on duty each shift. The home does have a quality assurance system in place that includes resident and relative surveys. The surveys had been completed but not yet collated and published so the results were not available. However, the manager said there were no issues arising from the feedback. Care Homes for Older People Page 19 of 24 Evidence: The home does not manage people finances for them and does not hold money for any residents. Staff supervision is taking place on a regular basis. Staff spoken with confirmed that they were receiving supervision and they felt well suported by the management team. We looked at the health and safety checks that the home is required to maintain and found these to be up to date. Testing was being carried out on small electrical equipment and larger equipment such as hoists were being serviced under contract. Fire safety risk assessments had been completed and all fire safety checks are being completed. The home are completing risk assessments for risks associated with the storage of products such as steradent in peoples rooms. We found that risk assessments stated these products should be locked away but they could still be seen in peoples rooms. Care Homes for Older People Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 27 18(1) People who use the service must be assured that there are sufficient numbers of staff on duty. 30/06/2008 2 30 18(1c) Staff must complete NVQ training to ensure they are appropriately qualified and competent carers. 03/09/2008 Care Homes for Older People Page 21 of 24 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 1 25 23 All parts of the home must be adequately lit. So that people can orientate freely and safely around the home. 05/01/2009 2 25 23 The home must have adequate communal bathrooms in use that are domestic and homely. So that peoples health and welfare needs are met. 26/01/2009 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 2 3 4 7 7 19 22 It is recommended that the service continues to develop a person cenred approach to care planning. It is recommended that individual care plans contain dated information relating to the reviews that are completed. It is recommended that the home continues with the plan of redecoration and refurbishment. It is recommended that the service continues to develop an environment that meets the needs of people with dementia Care Homes for Older People Page 22 of 24 type conditions. 5 38 It is recommended that the home takes action to ensure that action plans resulting from risk assessments are complied with. Care Homes for Older People Page 23 of 24 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 © (2009) 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 24 of 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!