Inspection on 09/01/08 for The Lodge

This inspection was carried out on 9th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Lodge Watton Road Ashill Thetford Norfolk IP25 7AQ Lead Inspector Kim Patience Unannounced Inspection 9th January 2008 11:00 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.V357537.R01.S.doc Version 5.2 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.V357537.R01.S.doc Version 5.2 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 Dementia - over 65 years of age (20) registration, with number of places The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2007 Brief Description of the Service: 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. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took approximately 6.5 hours to complete. During the inspection, a tour of the premises was completed, records relating to residents, staff and the service were inspected, observations of daily routines were made and staff and residents were spoken with throughout the day. What the service does well: What has improved since the last inspection? What they could do better: The home still needs to develop care plans and associated records, those seen did not contain up to date information relating to peoples needs. Risk assessments were generally poor and while they stated the risk there was no plan of action to minimise risk. People still need to be provided with meaningful social activity and stimulation and there is a lack of assessment of need in this area. Improvements are still needed around the provision of meals and the support provided to people at these times. The home needs to appoint a kitchen assistant at teatime so that care staff are free to provide the necessary supervision and support to residents. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 6 The work on improving the environment must continue and the home must review the cleaning regime to make it more effective. The home will not enhance its quality rating unless the area of health and personal care is improved. 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 summary of this inspection report can be made available in other formats on request. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 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.V357537.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate, as the home can provide sufficient evidence that people who use the service are provided with information that enables them to make an informed decision as to whether the home will meet their needs and expectations. However, the home cannot provide sufficient evidence that prospective users of the service have their needs assessed to determine that they can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A random inspection was carried out in December 2007. Records relating to two new residents, admitted for respite, were examined and showed that pre admission assessments had not been completed and therefore the home did not have sufficient information relating to the individuals needs and how they should be met. The two residents were admitted during the time the manager was absent and it appears that staff who were covering did not follow the correct procedures. The home should not admit new residents without first completing a pre admission assessment. See requirements. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 9 No new residents have been admitted since the random inspection so it was not possible to assess current practice. The home has a pre admission assessment procedure and now issues new residents with a contract. This is an improvement since the last key inspection. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor, as the home still cannot demonstrate that the health, safety and wellbeing of people who use the service is promoted through care planning, health assessments and the safe management of medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care records relating to four residents. We found that new documentation has been introduced and the new system has been in place for approximately three months. The records were still found to contain omissions in care planning, health and risk assessments. For instance, one resident had been into hospital and had a procedure to fit a tube directly into his bowel. This was not noted in his care records and it was only through observation of the resident that it was noted. There was no care plan in place and no risk assessment, even though care assistants were required to flush the tube twice daily and assist with changing the person’s colostomy bag that was fitted to the tube. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 11 It was also noted that the area around the tube had become sore and red and eventually started weeping, it was only after 10 days that the home contacted a GP following the advice of a district nurse who said he may have infection. The home now has food charts in place, however they were not being completed routinely and there were gaps in the records. In addition, the Malnutrition Universal Screening Tool (MUST) was not being completed in full. Risk assessments were generally poor, stating the risk but not the action to be taken to minimise the risk. For instance, a falls risk assessment was completed and identified the resident as high risk yet no plan of action had been written. Another care plan stated the resident can be aggressive but no risk assessment was written to instruct staff as to what steps can be taken to diffuse any situation that arises and protect people from potential harm. Daily care records were brief and lacked sufficient detail of how care is being delivered. Task sheets are in place for care assistants to complete when providing care such as washing and baths, but these records were not being completed consistently. It appeared from the records that a resident had one bath in several weeks when it stated elsewhere in the records that bathing should be completed twice weekly. Social care plans were written in some files and not in others and those that were seen lacked meaning. For instance, one stated the only social activity as walking, even though the file contained some previous history that could have been used to write a plan of activity that was consistent with the person’s previous experience. See requirements. It was also noted that there was no evidence of resident or relative involvement in the care planning process and the home must ensure that where possible residents/relatives are given the opportunity to contribute and agree to the plan of care. See requirements. The medication arrangements were inspected and were found to be good order. Since the last inspection the home has installed new storage cabinets for the safe storage of medicines and made significant improvements with medicine management in general. Medication administration charts (MAR) showed that medication appeared to be given in accordance with prescribed instructions. There were no gaps in the records and instructions were clear. A random audit was completed and no errors were found. A member of staff was observed during the lunchtime medicines round and her practice was good, however she was distracted at times when she needed to The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 12 attend to residents. This could be attributed to the low staffing levels at peak times. (See standard 27) There was still a concern about the quality of care plan guidance in respect of medication to be given ‘when required’. For instance, one resident was prescribed diazepam to be given three times a day ‘when required’. The medicine had been given consistently with no justification for doing so. The home must have care plan guidance in place for all medicines prescribed on this basis, so that staff know what steps should be taken before administering a psychoactive medicine and are able to demonstrate that they have tried other alternative methods. See requirements. In respect of privacy and dignity, there were several issues arising that show the home does not always promote privacy and dignity. For instance, one resident was seen walking into the dining room with tubes coming from his abdomen, these could have been covered by clothing in order to preserve dignity. Another example was the use of drinking cups designed for babies as opposed to specially designed adult drinking cups that promote dignity. Other examples are cited throughout the report. See requirements. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate, as the home cannot fully demonstrate that the service provided meets the expectations and preferences of residents. It also cannot demonstrate that choice and control is promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of inspection there was little activity. However, there was some disruption to normal routines caused by the flooring in the corridor being replaced. As mentioned in the previous section, social care plans were not written for some residents and for others the quality of information was limited. The home has started to gather information about people’s previous experiences and life history. This information needs to be used effectively to form a plan that promotes social experiences that are consistent with the person’s preferences and expectations. See requirements. During the inspection visitors were seen coming and going. One resident spoken with said her nephew visits every day without restriction and at The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 14 Christmas her family came for a gathering, which she enjoyed. She also stated that staff are very welcoming of people coming to visit. The mealtime experience was observed and the cook was spoken with. People are offered a choice of two main meal options for lunch and a variety of light foods at teatime. The home does not have a way of publicising the meals on offer for the day and it is recommended that menus are displayed in a format that is suitable for the needs of older people with dementia. Most residents were seated in the dining room for lunch, the tables were laid in a way that promotes recognition of dining. The cook served the main meal and had already spoken with each resident to ask for his or her preferred meal choice. The cook also offered people choices such as Black current or orange drink and this is good as it promotes independence and control. The meal served looked appetising and residents appeared to enjoy the meal. At the last inspection a requirement was made in respect of liquidised foods, which were presented in a bowl all mixed together, the findings were the same at this inspection. The home must present liquidised food in separate portions so that people can continue to experience the different tastes, textures and colour. See requirements. A member of staff was observed to help a resident with dining and for most of the time she stood by the side of the resident helping to put food from the bowl into her mouth. This does not promote privacy and dignity and the care assistant should have sat by her side discreetly, giving the person time to eat at her own pace. See requirements. The teatime experience was also observed and at this time of the day the staffing levels are reduced for the evening shift. It was chaotic and clearly staff were finding it difficult to meet the residents needs. There are no kitchen staff available at teatime which means care staff are responsible for serving tea. The cook said that she prepares sandwiches and cakes before she leaves so staff only have to serve them. However, this limits people’s choices to what is manageable for staff at the time. One care assistant spoken with said it is difficult to manage at this time of the day and they would benefit from a kitchen assistant. See requirements. The home still does not maintain a record of people’s dietary intake as required at the last inspection. Although, food charts have been introduced in the residents records but they are not completed daily and are unreliable. The home must find an effective way of recording people’s dietary intake. See requirements. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good as the home can provide sufficient evidence that they have systems in place to ensure the protection of residents and that peoples concerns are listen to and taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a policy and procedure in relation to complaints that is publicised in the service users guide and posted in the reception area of the home. The manager said she hasn’t received any complaints since the last inspection and that the home has a complaint log in place to record any complaints made. In respect of adult protection, the home has not had any adult protection concerns and all staff are trained in the protection of vulnerable adults. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate, as the home provides fair accommodation and maintains a reasonable standard of cleanliness. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was completed and some resident’s rooms were entered. A random inspection was completed in December and highlighted concerns about hygiene and cleanliness around the home. Since that inspection the standards have improved. The orange lounge has been redecorated, new chairs have been purchased and the carpet is due to be replaced. On the day of inspection a new carpet was being laid in the corridor. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 17 Radiator covers have been purchased and were in the process of being fitted. Most areas were reasonably clean and tidy, however, cleanliness could be improved in some areas. For instance, in one bedroom the carpet was soiled and in another there was food on the floor that appeared to have been there some time. The communal facilities were cleaner than before, but again could be better. There was still an odour in one of the toilets and one bathroom on the first floor is in need of refurbishing. Some of the resident’s rooms are in need of redecoration as they are looking shabby and worn and odours could still be detected in some. The home employs a domestic who works 25 hrs per week over 5 days. The home may want to consider reviewing the cleaning regime to make it more effective. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate as the home can demonstrate that there are sufficient numbers of trained and competent staff to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection a requirement was made to increase the staffing levels and this has been met. The home is currently accommodating 16 residents and the staffing levels have been increased to 3 care assistants on duty during the waking day and 2 during the night. The manager is no longer included on the staff roster and this means she has more time available for management tasks. However, as mentioned in the previous section the staffing levels are low at teatime as there is no support with serving meals and this task is allocated to care staff. The home must employ a kitchen assistant to allow staff to concentrate on providing care. See requirements. The home has an annual training and development plan that shows all mandatory training is provided in addition to specialist training such as dementia awareness. Training has been planned for February 2008 and will be delivered by an external training provider. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36 and 38 Quality in this outcome area is adequate, as the home can now demonstrate that there are management systems in place that promote the health and welfare of residents, however there are still improvements to be made here. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a registered manager who shows commitment to providing good care for people who use the service. The manager has completed ongoing training relating to her management role and she is currently undertaking a course in advanced dementia studies with the university of Bradford. The concerns highlighted at the last inspection in relation to the manager working hands on are no longer an issue and this is good as time can now be devoted to management tasks. The home has also employed a deputy manager who will support with management tasks. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 20 The home has a quality assurance system, which includes stakeholder surveys. The quality assurance system is progressing well and annual surveys have been sent to all stakeholders. Some of the surveys were available for inspection and on the whole showed positive results. Ways in which the results can be published were discussed, for instance a newsletter is a good way of disseminating this kind of information. The manager has now introduced a plan of staff supervision and the records were available in the staff files. In addition, regular team meetings are held and this is good. In respect of health and safety, there are some issues highlighted in this report in relation to risk assessments that must be addressed. Otherwise, there were no major concerns in relation to health and safety. Fire safety checks are completed in accordance with the regulations and staff are trained in fire safety procedures. All other equipment such as hoists and small electrical are tested at regular intervals and records relating to the checks were available for inspection. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 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 X X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 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 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 2 The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 22 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. Standard OP7 Regulation 15(1)(a) Requirement People who use the service must be assured that their holistic needs are fully assessed and updated regularly so that their health and welfare is safeguarded. This must include the use of PRN medicines. People who use the service must be assured that risks to their health and welfare are assessed and a plan of action to minimise risk is written so they are safeguarded from harm. People who use the service must be assured that nutritional needs assessments are completed to ensure that people’s nutritional needs are met appropriately. People who use the service must be assured that the home will maintain records of individual’s dietary intake so that it can be determined whether the diet is satisfactory. Timescale for action 30/06/08 2. OP8 13(4) 30/06/08 3. OP8 12(1)(a) 30/06/08 4. OP15 17(2)sche dule 4.13 30/06/08 The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 23 5. OP15 16(2)(i) People who use the service must be assured that Liquidised food will be prepared and served in separate portions to give people the opportunity to experience various taste and texture and promote dining that is consistent with previous experiences. People who use the service must be assured that assistance to dine will be provided discreetly and sensitively so that their dignity is promoted. People who use the service must be assured that their privacy and dignity will be promoted at all times. Staff must complete NVQ training to ensure they are appropriately qualified and competent carers. People who use the service must be assured that there are sufficient numbers of staff on duty at teatime. 30/06/08 6. OP15 16(2) 30/06/08 7. OP10 12(4a) 30/06/08 8. OP30 18(1c) 03/09/08 9 OP27 18(1) 30/06/08 The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 24 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 OP26 Good Practice Recommendations People who use the service must be assured that the home will be kept clean and hygienic. The Lodge DS0000027322.V357537.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 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 © 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.V357537.R01.S.doc Version 5.2 Page 26 - 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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