CARE HOMES FOR OLDER PEOPLE
The Lodge 8 Lower Road Bedhampton Havant PO9 3LH Lead Inspector
Carole Payne Unannounced 26.04.05 9:30am 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 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 H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Lodge Address 8 Lower Road, Bedhampton, Havant, PO9 3LH Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 023 9245 2644 The Manor Trust ( Bedhampton) CRH 14 Category(ies) of OP - 14 registration, with number of places The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: N/A Date of last inspection 02.11.04 Brief Description of the Service: The Lodge is owned by the Manor Trust. Mrs Sandra Marais has made an application to the Commission for Social Care Inspection to become the registered manager of the service. The home is situated in a quiet location in Bedhampton and is within easy reach of local amenities, bus and rail links. There is a small shop in the home for purchasing small items. A driveway to the front of the property leads to parking facilities. There is a handrail to the front door and level access from the home to the pleasant and well tended gardens to the rear of the property. The home is a detached property, which benefits from an extension. The home has fourteen single rooms, eight of which benefit from en suite facilities. The home has two lounges and a dining room. There are two assisted bathrooms in the home and showering facilities. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The home’s first inspection for this year took place on Tuesday 26th April 2005 between 09.30 and 15.00. The visit was unannounced. During the inspection discussions took place with five of the twelve people living at the home. The inspector also met with Sandra Marais, the proposed registered manager of the home, the deputy manager, and three carers on duty during the course of the day, the home’s cook, the domestic worker and the handyman. Care records were seen for three people living in the home and the home’s policies and procedures were sampled. The inspector toured the building and observed the daily routine in the home. What the service does well: What has improved since the last inspection?
Since the last inspection a handrail has been fitted going up to the entrance to the home and there has been some redecoration. Locked storage facilities have been provided for hazardous substances in the home. Service users are being asked more about what they think about the service and their views are being taken into consideration when making decisions about the running of the home. Service users have been asked what they think
The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 6 about the social activities in the home and there was agreement that most service users would like to have more things going on. There are now more social opportunities available. The manager has made a list of training for all staff members so that she can easily see when training is required and is intending to implement appropriate training, which will be updated on a continuing basis. 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 H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 standard(s) 2 3 4 5 The service was satisfactorily supporting service users to find out what it is like to live at The Lodge prior to making a decision about moving in. EVIDENCE: One service user said that she had been made to feel very welcome when she moved into the service. She felt that staff members supported her well and enabled her to settle into her new home very quickly. Her relative had been made welcome to visit the home prior to making a decision about moving in. The manager said that service users who are considering moving into the home are encouraged to spend time at the service before they decide to move in and that a trial period of stay supports service users to experience life at The Lodge. A signed copy of terms and conditions was not on file for a new service user. The manager confirmed that a relative had been given a copy of the document for consideration when the service user moved in. A copy of a signed agreement was seen for another service user living at the home. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 9 The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 standard(s) 7 8 10 Care plans are clearly set out, with headings of all aspects of daily living. Some information in care plans is not adequate to support staff members to provide care. The service promotes other aspects of health and well being of service users living at the home. All staff members were respectful and sensitive in the way that they supported people living in the home. EVIDENCE: Care plans are drawn up in consultation with the service user. Details about service users’ needs and wishes had been recorded. This had enabled staff members to carry out care according to service users’ preferences. One service user said that she felt that the home was enabling her to make the ‘most of every day.’ Three care plans were seen. These reflected specific problems and needs. However, they did not, in some instances, identify how the care was to be carried out. For example, one care plan said that the service user had a problem communicating, but did not go on to say how best to address the problem. A care plan for a service user with diabetes did not tell the reader what type of diabetes the service user had, any care needed, and how to recognise and respond to unstable diabetes. One person living in the home needed encouragement to drink; this had been recorded in a review of care.
The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 11 This had not been included in the care plan, which did not, therefore, reflect changing needs. One service user said that he receives visits from the district nurse. He has access to a General Practitioner as needed and other healthcare professionals as required. A service user said how much she feels supported by staff working at the home. They are ‘so caring and kind.’ She feels ‘at home’. She has her own telephone and precious things around her, and her room is her ‘own.’ Staff members approached service users with great care, and were respectful in the way that they addressed and offered help to people living in the home. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 standard(s) 12 13 14 15 The home offers a range of social opportunities to service users. Service users’ friends and families are made to feel part of the life of the home. Great care is taken to ensure that service users are offered choices and that their wishes are respected. The standard of food provided is very good. Mealtimes are events, which are shared and enjoyed by service users and staff members. EVIDENCE: A service user described the varied quality of life enjoyed in the home. She was looking forward to going out with a relative. On the day of the visit there was a birthday celebration and a visit from the hairdresser to the home. One said how much she enjoys the companionship of other people living in the home. At lunchtime some service users met in the dining room for lunch. The manager had asked service users whether they would like to have background music playing whilst they had their mid day meal. Hence soft music was playing whilst people shared lunch together, chatting at small tables and eating the delicious home cooking prepared by the home’s cook. A staff member was sitting at a table with service users eating her own meal. She chatted to service users and provided sensitive support to a person needing help with eating.
The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 13 The cook said how much she enjoys working at the home. She has a varied menu plan, which she rotates on a five weekly cycle. She shares her role with another cook over the seven-day week. A delivery van arrived on the morning of the inspection to bring local fresh fruit and vegetables. A service user described food as ‘out of this world.’ One service user who has a diabetic diet said that the home provides her with a varied specialist diet. In the afternoon a service user was entertaining some visitors on her birthday. The visitors said how much they enjoyed coming to the home. Staff members had made a birthday cake, which had been beautifully decorated. Since coming to the home the manager had undertaken a survey about activities and she has started to use the results to improve the opportunities offered by the home. She told of how this had led to setting up shared events with The Elms and The Manor, which form part of The Manor Trust supported living accommodation. There had recently been a coffee morning, which had involved the people living at The Elms and The Lodge, which the manager said, had been a success. Activities available include bingo, exercise classes and craft sessions. Barbeques, outings and garden parties are planned for the warmer weather. Information was displayed in the home about a musical show, which had been arranged. The manager had booked a place on an activities day with Age Concern to learn about new ideas for social opportunities. One service user said that she is offered choices about what she does. The Lodge is ‘home’, enjoying time spent in her own room and that spent sharing the companionship of other service users. It did not feel like ‘care’, it felt like enabling people to live independently and enjoy a good quality of life. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 standard(s) 18 Adult protection training is not adequate to ensure that staff members are aware of issues of abuse. EVIDENCE: A senior member of staff at the home was not aware of the lead agency if an allegation of abuse was made in the home. Although some had studied this as part of training towards National Vocational Qualification [NVQ], staff members said that they had not had recent training in the protection of vulnerable adults at the home. The new manager was in the process of organising suitable training. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 standard(s) 19 24 Much thought has gone into providing an environment, which enables service users to live comfortably and independently in a house they can call ‘home.’ EVIDENCE: Since the last inspection a handrail has been fitted going up to the home’s front door and two rooms have been redecorated. Locked storage has also been provided for hazardous substances in the home. The home has a delightful well-maintained garden, which service users can go out and enjoy in warmer weather. Two service users said how pleased they were with their rooms. They had been able to bring personal possessions; had telephones and a call alarm, which they said was answered promptly if they needed to ring for help for any reason. All rooms are fitted with a lockable storage facility which one service user said he finds very useful. One room had been carefully decorated using stencils, which matched other soft furnishings in the room. The service user said how much she felt that this was a place she liked to be and how impressed she was that staff took such care to make the rooms ‘home.’
The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 16 The toilet on the first floor has no basin. There is limited room in the toilet. However, this did not appear to present a problem to the service users living on this floor who all have basins in their rooms. The home may wish to consider fitting alcohol gel dispensers. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 28 29 Staffing levels did not meet the changing needs of the service at the time of the visit. Staff members carried out their work in a caring and competent manner. The home’s vetting procedure for new staff was not sufficiently rigorous. [See judgement for Complaints and Protection and Management and Administration for further comments regarding training provided in the home]. EVIDENCE: There were two members of care staff on duty on the morning of the visit as well as the deputy manager, a domestic worker, handyman and cook. The manager came in to meet with the inspector. One service user was requesting help during the visit and staff members did their best to respond. During the day they faced choices between going to, or staying with this service user, or attending to other service users requiring support. The new manager of the home has audited the training records to identify training required for staff members working in the home. Priorities for training have bee identified. Staff working in the home went about their work in a confident and competent manner. Thirteen out of the twenty-six members of staff working at the home hold a National Vocational Qualification in care [NVQ]. A further four members of staff are studying at the moment for an NVQ award.
The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 18 Recruitment records were viewed for three members of staff. One application form did not clearly state what the status of a referee was. Friends, rather than those with a professional relationship provided two references for the applicant. One health declaration indicated that the staff member had experienced health problems. There was no record of whether the problems had been followed up to ensure that the person was fit and able to carry out the role of a care worker. Work histories were incomplete and there was no written exploration of reasons for any gaps in employment history. One person had started working in the home before written references had been received. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 38 People living at the home and each staff member contribute to the way the home is run. There are shortfalls in updating training courses, which are essential for the work carried out by care staff working in the home. Fire doors in the home were seen to be wedged open. EVIDENCE: The manager of the home has started to introduce new systems of quality assurance. She has asked people living in the home their views about the activities provided. She had used the information to make available opportunities, which reflected what people living in the home would like to do. A residents’ meeting had also taken place recently and one service user said ‘it is nice to be asked what we think.’ Staff members said that they also meet together both formally and informally. Each member of staff is valued and takes part in discussions.
The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 20 An efficient system has been devised for monitoring staff training in the home, to identify when training needs to be updated. Currently ten members of staff need to undertake an update course in manual handling and six require food hygiene training. Staff members working in the home are involved in the support of service users when moving around the home and in food preparation. The office door and the door to one of the bathrooms are fire doors. These doors were wedged open during the inspection. There was no device fitted to either door to allow them to close in the event of a fire. Advice should be sought from the Fire Safety Officer and acted upon appropriately. One room had a slight step at the entrance to the room, which presents a tripping hazard. The manager agreed to appropriately look at minimising the risk. The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x 3 x x STAFFING Standard No Score 27 2 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 3 x x x x 2 The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 22 NO Are there any outstanding requirements from the last inspection? 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 7 8 Regulation 15 12 Requirement Care plans must detail how care is to be carried out. Care for service users with diabetes must be planned to support service users in caring for a service user with diabetes. Staff members must receive training to prevent service users being harmed, or suffering abuse or being placed at risk of harm or abuse. The service must provide appropriate support to an identified service user, including within the timescale, an additional member of staff on each shift as approriate. This was issued as an immediate requirement at the time of the inspection. As part of the homes recruitment procedure two written references must be taken prior to starting employment, care must be taken to ensure the authenticity of references, a complete work history must be provided and any health issues must be explored to ensure fitness to work. Staff members must receive up Timescale for action 30 June 2005 15 June 2005 31 July 2005 3. 18 13 4. 27 18 26 April 2005 5. 29 19 15 June 2005 6. 38 13 and 18 31 August
Page 23 The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 7. 38 23 to date training in manual 2005 handling, food hygiene, infection control and health and safety. The fire door to the office and 31 May one bathroom in the home must 2005 not be wedged open. Appropriate discussion with the fire safety officer and appropriate measures actioned. 8. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Lodge H54 S11643 The Lodge V223582 260405.doc Version 1.30 Page 24 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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 H54 S11643 The Lodge V223582 260405.doc Version 1.30 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. 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!
