Inspection on 09/11/07 for The Lodge

This inspection was carried out on 9th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12/09/06

The Lodge 21/12/05

The Lodge 26/04/05

The Lodge 02/11/04

The Lodge 20/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE The Lodge 8 Lower Road Bedhampton Havant Hampshire PO9 3LH Lead Inspector Tim Inkson Key Unannounced Inspection 9th November 2007 08:55 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 DS0000011643.V349811.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 DS0000011643.V349811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge Address 8 Lower Road Bedhampton Havant Hampshire PO9 3LH 023 9245 2644 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) The Manor Trust (Bedhampton) Janette Heather Waller Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th September 2006 Brief Description of the Service: The Lodge residential home is part of an integrated scheme run by a trust (Manor Trust) as a registered charity, in the area for the care and accommodation of older people. Accommodation is provided at other locations (The Manor House, The Elms and The Waterloo Room) for people who are more active and not in need of personal care (but who receive companionship and support). The Lodge came into being in 1981 to meet the needs of people who were becoming too frail to live independently at the Manor House/Elms. The home provides accommodation on the ground and first floors. Local amenities, bus and rail links are within easy reach. The home is surrounded by landscaped gardens and is situated in a quiet, scenic area. It has 14 single bedrooms (8 of which have en-suite facilities) and communal areas. Twentyfour hour care is provided with 2 members of staff (awake) on duty at night. People wishing to live in the home or for whom arrangements are made to do so by relatives or other representatives are given written information about the home and the service that it provides and are also invited to visit the home. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection (“the Commission”) is made readily available in the home. At the time of this key inspection of the establishment on 9th November 2007 its fees ranged from £1610 to £1810 a month. This did not include the cost of personal toiletries, chiropody treatment and hairdressing. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 9th November 2007, starting at 08:55 and finishing at 14:10 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and other facilities. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. People living in the home, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 14 people. Of these 2 were male and 12 were female and their ages ranged from 76 to 102 years. No individual was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. People living in the home, their relatives and advocates as well as health care professionals in contact with the home, were canvassed for their views about the home using questionnaires, before the site visit took place. Their responses were taken into consideration when producing this report. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the registered manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 10th October 2005, such as, complaints and statutory notices about incidents/accidents that had occurred. What the service does well: People living in the home were safe and believed that staff looked after them properly and treated them with respect. They were able to make choices about their preferred lifestyle and exercise personal autonomy. Positive views were expressed about the food provided by the home by people living there. They were pleased to be able to participate in a range of activities and also with the condition of the accommodation that they occupied. Staff, people living in the home and relatives had confidence in the effectiveness of the home’s manager. Management systems and procedures in the home worked well including, the administration of medication, dealing with complaints, quality monitoring, and health and safety. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 6 There was a commitment to promoting equality and diversity and staff support, training and development. The latter was reflected in the high proportion of care staff (88 ) with a relevant formal qualification that ensured that they were able to fulfil their roles and responsibilities and meet the needs of people living in the home. What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. The Lodge DS0000011643.V349811.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 DS0000011643.V349811.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and their relatives/representatives were confident that the home could meet their needs. This was because the help that individuals required was identified before they moved in to ensure that the level of support and care they required could be provided. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with the actions that the home took to identify the help and assistance that people needed. As on the last key inspection of the home on 12th September 2006 there was also evidence on this occasion, from the documents examined and discussion with people living in the home and or their relatives. Admissions to the home of the individuals had all been planned and involved staff working in the home that had appropriate knowledge and skills. The process of people moving into the home included getting confirmation from the doctor/general practitioner of the person concerned indicating that the level/type of care that the home provided (i.e. assistance with personal care) would be suitable to meet the needs of that individual. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 9 Where an individual had moved into the home through arrangement made by the adults services department of a local authority, a copy of that department’s assessment of the person’s needs had been obtained by the home. The home’s registered manager said that she usually carried out the assessments of the needs of people wishing to move into the home. She said that the process included, both visiting people who wished to live in the home where they were accommodated as well as the individual visiting The Lodge before they moved in. This was in order to identify the degree and type of help that they needed. There was documentary evidence that assessments of individuals’ needs were reviewed at least every month and revised as necessary when a person’s circumstances changed. The home does not provide intermediate care The Lodge DS0000011643.V349811.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 good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs were met. The home had plans of care that individuals, or someone close to them, had been involved in making. People unable to manage their own medication were supported by the home to manage it in a safe way. Individuals’ right to privacy was respected and the support they got from staff was given in a way that maintained their dignity. EVIDENCE: Plans of care were examined of the same sample of 4 residents as in the section above i.e. “Choice of Home”. The documents seen were based on the information obtained from assessments that the home carried out in order to identify what help the individuals needed. Assessments included a range of potential risks to residents such arising from things such as, pressure sores, falls, moving and handling and malnutrition. There was some discussion about ensuring that assessments of risk were not completed in isolation and ensuring that they were always linked to and informed the plans of care of the person concerned. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 11 The plans examined set out the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required e.g. “cut up food and serve on high-lipped plate; provide gluten free diet; walks with stick”; etc. Where care plans examined referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place. There was evidence from documentation and discussion with individuals, that wherever possible they and/or their representatives had been involved in developing the plans and had agreed with the contents. Records also indicated that risk assessments and care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Care plans examined were not simply task focussed. They were person centred and identified very specific wishes of the persons concerned e.g. “On going to bed she likes to have … placed by her shoulder”. They also included many references to the fundamental principles that underpin social and health care such as independence, privacy, dignity and choice and entries in plans illustrating this included the following: • “Ensure D is supported and helped to look clean and smart to promote her self esteem”. • “Aim to maintain M’s independence … needs some help with tights and trousers” • “Aim to maintain Y’s dignity and independence – ensure that she takes her medication and make sure she had her GTN spray with her at all times”. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and relatives/representatives about the abilities of staff the care and support that they provided included: • “I have my own care plan and I agreed it with them … I don’t need a lot of help but someone stays in the bathroom with me to make sure that I am alright … “. “They help me get dressed and bathed. I feel confident that they know what they are doing. They are polite and helpful … “. “We have been very satisfied with the care he has received … the carers spend time talking to them when dealing with them and don’t rush them … “. • • Responses in questionnaires returned by relatives of people living in the home indicated that 50 believed that the home always gave the support or care to The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 12 their relative that they expected or agreed and 50 usually. Also 50 thought that the staff always had the skills to look after people properly and 50 usually. Comments in questionnaires included the following about what they thought that the home did well: • “They are sensitive to residents needs and wishes”. • “ The staff are very caring, considerate and patient”. • “The carers attend well the needs of my elderly and sometimes difficult parent. They seem vigilant and knowledgeable about daily needs and handle difficult situations with tact and understanding”. Records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Individuals and relatives said that people received treatment from among others, doctors, podiatrists and opticians. At the time of the site visit a community nurse visited the home in order to assess the mental health condition and needs of an individual. It was suggested that all care plans should include specific details about how the eye, oral hygiene and foot care needs of individuals would be met. Individuals’ weight was monitored routinely and regularly and specific plans were implemented when weight loss or eating difficulties had been identified as a problem. Records would be kept of their food and fluid intake and if the difficulty persisted advice and support was sought from the doctor of the person concerned. The home’s registered manager said that if any specialist equipment (e.g. pressure relieving aids or continence products) was required because of particular health care needs of individuals living in the home that these were obtained through the relevant healthcare professionals i.e. continence advisory service or district nurse. Questionnaires returned by doctors that had contact with the home indicated that 100 were of the view: • The home communicated clearly and worked in partnership with them. • There was always a senior member of staff on duty to confer with. • They were able to see their patient in private. • Staff demonstrated a clear understanding of the care needs of people in the home. • People’s medication was appropriately managed in the home. • The overall care provided by the home was satisfactory. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in locked room. In the room it was kept in a secured metal medicine trolley. A locked cupboard secured to the wall and a small The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 13 refrigerator. Controlled drugs were stored securely. A sample audit of controlled drugs indicated that the relevant records were accurate and up to date. It was suggested that advice be obtained as to whether the cupboard used to store controlled drugs complies with the standard required under the Misuse of Drugs (Safe Custody) Regulations) 1973. The home used a monitored dosage system with most prescribed medication in blister packs. All staff that were responsible for giving out medication had attended a training course in “Safe handling of Medication”. A requirement had been made following the last inspection of the home on 12th September 2006 that all care staff receive training in the administration of medication. This had subsequently been complied with Good practice noted during the fieldwork visit included: • Sample copies of the signatures of the care staff that gave out medication. • The dating of some medicine containers when they were opened. • Recording the temperature of the refrigerator where some medication was stored to ensure that it was working effectively. There were detailed instructions about the use of topically applied creams for one person and a clear system in place with accurate records for the receipt, administration and disposal of unwanted/unused medicines. Staff were observed giving out medication at lunchtime. Following this there was some discussion with the registered manager about the dangers associated with double dispensing of medication that the home had for a person who had recently moved into the home and had not been put into the blister packs. Also need for staff to witness people taking their medication before signing the relevant medication administration charts/record. At the time of the fieldwork visit no person was managing all of his or her own medication. The importance of offering people the opportunity to do so based on an assessment of their ability/competence and recording the outcome of the assessment was part of a general discussion about the management of medication and individuals’ rights in the home. People spoken to during the site visit confirmed that staff promoted their privacy and dignity and were polite and respectful and knocked on their bedroom doors and waited for permission before entering. This important aspect of life in the home was assisted by the fact that all bedrooms were single. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and according to the choices and preferences of those living in the home. EVIDENCE: Observation and discussion with people living in the home, relatives and staff indicated that the home’s routines were very flexible and the service it provided was based clearly around the needs and wishes of those living there. People chose when to get up and go to bed and where to eat i.e. either in their rooms or the communal dining room. The home’s written policies including the “Maintenance of Individual Life Styles, Citizens Rights, Sexuality and Personal Relationships”, illustrated how not only how choices of people living there were promoted but also how equality and diversity was addressed. It included the following statements: • “Residents will decide whom they will receive as visitors and the times and the occasions of any visits”. • “Staff will respect resident’s rights to develop and maintain a variety of relationships which may reflect their sexual identity and orientation”. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 15 • “Residents will not be patronised”. There was a large lounge where there was a television and where organised communal activities took place. There was also a small quiet lounge where people living in the home could entertain their visitors or pursue their particular interests if not wishing to join in with organised activities. There were a range of board games readily available for the use of people living in the home and one person said that she enjoyed playing scrabble and had done so since she had moved into the home, some weeks before the site visit took place. Special occasions were celebrated in the home and staff organised various activities. A craft group had been established and a number of people had been involved in making Christmas cards. Entertainment was arranged using musicians/singers and a clothes show was due to take place before Christmas. Local clergy visited the home regularly. People living in the home and visitors that were spoken to during the site visit confirmed that there were no restrictions and visitors said that that they were always made welcome. The home did not manage the financial affairs of anyone living there. Individuals were able to bring personal items into the home including furniture and it was apparent from discussion and observation during a tour of the building that many people had taken some trouble to personalise their bedroom accommodation. There was a lot of information readily available in the home about local advocacy and other services. Sensitive information that the home held about individuals was kept secure and the home had written policies and procedures about maintaining confidentiality and the right of people living in the home to access their personal files and case notes. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided and an alternative could always be provided to the main meal of the day. People were asked about what they wanted for the main meal of the day and the evening meal. Individuals’ food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plans. The information was also readily available in the home’s kitchen. Special diets and individual and special needs were catered for e.g. diabetics and gluten free. Fresh ingredients were used in the preparation of meals with vegetables form the home’s garden used in many meals. On the day of the site visit fresh The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 16 parsley from the garden was used in a sauce. The ready availability of fluids and fresh fruit was noted. People spoken to said that they received 3 meals a day and could have drinks and snacks at other times. Comments about the food provided were all positive and terms generally used to describe it were either “lovely” or “very good”. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. If people had concerns with their care, they or people close to them knew how to complain. Any concern would be looked into and action taken to put things right. The care home safeguarded people from abuse and neglect and took action to follow up any allegations. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. There was also a copy of the home’s service users guide that was given to everyone when they moved into the home. People living in the home and visitors spoken to during the site visit were confident about raising any concerns. Comments about this included: • • • “I would speak to one of the girls or the one in the office”. “If I had a complaint the machinery is in place for addressing it”. “I could take any complaint to her if I was concerned”. A record of complaints made to the home was kept that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been no complaint made to the home in the previous 12 months. The The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 18 Commission for Social Care Inspection (CSCI) had also received no complaint about the home during the same period. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. One example of the home’s approach to safeguarding people living there was illustrated by the policy about individual lifestyles referred to in the previous section (above “Daily Life and Social Activities”). It included the following statement: • “… This policy applies to all residents, who have full capacity to make their own decisions about how they lead their daily lives. The same rights should be accorded to residents who lack the capacity to take decisions without guidance, except that they will need to have any risk to their or others welfare assessed with interventions based on the outcome of the assessment …”. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable, safe and well maintained. The home’s procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was also no unpleasant odour anywhere in the building. Railings were installed in the corridors of the home and there were assisted bathing facilities. A stair lift provided access to bedroom accommodation on the first floor of the building. Slide sheets and other suitable equipment were readily available for transferring and assisting people with poor mobility and weight bearing difficulties. The home’s registered manager said that they were looking into the purchase of a new hoist that could be readily and easily stored when not in use. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 20 There was some discussion about the installation of a loop system to enhance facilities for people with hearing impairments who used aides. Also the use of colour schemes to provide discreet assistance for individuals who may have or develop short term memory problems, to orientate themselves in the home and readily identify facilities such as WCs. The home’s registered manager said that new carpet had been installed in some communal areas as the home had successfully obtained a grant through a central government initiative “Dignity in Care”. She also stated that there was an intention to improve the safety of pathways in the garden, which would enhance its accessibility to people living in the home. Everyone living in the home that was spoken to was complimentary about their personal and shared accommodation, the location of the home, and the buildings facilities including its garden. The latter was neat and well kept and the home employed a part time gardener and one of the trustees of the organisation that owned the home carried out simple repairs and maintenance to the building. Relevant contractors carried out regular servicing of the home’s plant, systems and equipment or major works when required. The home had comprehensive procedures in place concerned with infection control and all staff working in the home had completed relevant training. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 21 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, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People had safe and appropriate support as there were enough competent staff on duty at all times. They had confidence in the staff at the home because checks had been done to make sure that they are suitable to care for them. Peoples’ needs were met and they were cared for by staff that had received relevant training and also had support from their manager. EVIDENCE: The staff working in the home comprised: • 16 care assistants • 2 cooks • 1 cleaner • 1 gardener Out of the team of care assistants 14 (88 ) had obtained a recognised relevant qualification i.e. National Vocational Qualification (NVQ) to at least level 2 in care. Another care assistant was working towards obtaining the qualification. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 08:00 to 14:00 14:00 to 20:00 20:00 to 08:00 3 3 2 wakeful The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 22 The home’s registered manager was supernumerary and was on duty and available at least 5 days a week. Ther had only been one new member of staff employed since the last key inspection of the home on 12th September 2006. The reason for the low staff turnover was reflected in the comments made by staff when describing what it was like to work in the home. All spoke very positively about the working in the home, their colleagues, assisting the people living there and they also expressed particular enthusiasm about training and development opportunities: • • “The chance to learn here is very good, we are encouraged to go on training … “. “ … I have worked in other homes, it is really good here. The food is good it is nice and clean. I had no proper training before I came here and I have done lots since I have been here. I think the staffing levels are fine, if there were any more of us on we would get bored … “. “ … We work as a team …”. “…The training is very good and it helps me do my job properly. We all get on well considering we are a load of women … We are allowed to use our initiative, if you feel that someone is unwell you are allowed to call a doctor for them”. • • People living in the home and their relatives spoken to as well as responses received from the latter in questionnaires indicated that they believed that staffing levels were satisfactory and that the staff were skilled and competent. • • • “There is always someone available if you need help … ”. “I think that there are enough staff”. “I am totally confident that they know what they are doing when they help me … “. Documents examined of the one member of staff who had started work in the home in the previous 14 months indicated, that all the necessary preemployment checks to ensure that they were suitable to work with vulnerable adults had been completed before they had started work in the home. All new staff received comprehensive induction training and health care assistants completed a common induction standards programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 23 Staff training needs were identified through appraisals and individual supervision sessions and documentary evidence of regular supervision was seen. Staff spoken to confirmed that they participated in regular individual supervision sessions. The home’s registered manager kept a central record of all training that staff had completed and could identify readily the training needs or requirements of any individual in the home’s staff team. It was evident that apart from NVQ training staff attended regular updates in statutory health and safety and other essential subject matters as well as topics relevant to the specific needs of people living in the home e.g. loss and bereavement; blood pressure and hypotension; diabetes; challenging behaviour; moving and handling; fire safety; infection control; first aid; basic food hygiene; and adult protection/abuse. The home was also working with a consultancy service funded by the Learning and Skills Council. This was to obtain advice and support on workforce development issues e.g. skills profiling, accessing the right training, and workforce planning. There had been 3 requirements arising from the last key inspection of the home on 12th September 2006 and two were concerned with staff training. One required all care staff to be given training in the administration of medication and the other that staff involved in the preparation of food were given training in basic food hygiene. There was evidence from documentation seen and discussion with staff that both requirements had been met. The third requirement was concerned with the need to provide staff with regular and formal supervision. There was also evidence from discussion and documents examined that progress was being made with this matter. One member of staff spoken to said: • “I have supervision about every two to three months, we talk about problems and so on, but I can go and talk at any time”. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s registered manager had been in her post and responsible for the day-to-day operation of it for 2 years. Prior to taking up the position she had worked in other care homes in management positions including a care home providing accommodation for up to 30 older people for some fifteen and a half years. She had obtained a relevant management qualification in 2007 (The Registered Managers Award) that indicated that she had the skills and knowledge considered necessary to enable her fulfil her role. She ensured that she kept up to date with developments by attending training courses including one some weeks prior to the site visit that was about legislation recently implemented i.e. The Mental capacity Act 2005. She had developed links with a The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 25 training initiative for care services in independent sector funded and organised by the adults services department of the local authority. Through this she had completed “train the trainer” courses in several subjects that enabled her to “cascade” training to staff in the home. From discussion with the registered manager, observation and discussion with staff, people living in the home and visitors it was evident that the registered manager was; knowledgeable; organised; highly motivated; enthusiastic; and she kept up to date with developments in social care. Comments from staff, people living in the home and relatives about the registered manager were all positive and included the following: • • “ …She is alright, if she does not have the answer she will go and find out …”. “… We have had several managers since I have been here, she has settled in and is very good. She is approachable and she has helped a lot because she knows a lot …”. “She is brilliant, she has taught me a lot and she makes sure that the standards are high and that everything is done properly …”. “… She is very easy to get on with and very approachable, she has got a lot sorted out since she came here …”. “They had a number of changes of management and she seems very efficient and understands what is needed. Everything seems well organised now …”. • • • The home had system in place for monitoring the quality of the service that it provided based upon the regular use of questionnaires to obtain the views of people living in the home and other interested parties. The outcomes of surveys were published and readily available with a range of other information about the home in its entrance hall. As the result of such consultation some things in the home had been changed including, menus. The number of evening buffet meals had been reduced, individual linen baskets introduced and organised activities had reviewed. A representative from the trust/organisation that owned the home visited the home at least once a month. A report was completed of findings and observations made during such visits and copies were readily available in the home. There were a range of written of policies and procedures available that staff aid helped to inform their working practice. There was evidence that they were reviewed and updated as necessary. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 26 The home looked some money on behalf of some people living there. A sample of records was checked against the relevant balances being held and they were accurate and up to date. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. stair lift and bath hoists; fire safety equipment portable electrical equipment; hot water system; etc. Records were kept of accidents Staff spoken to said and records examined, confirmed that that they attended regular and compulsory fire and other health and safety training. Matters requiring remedial action that had been identified by the local Fire and Rescue Service on 23rd October 2007 were being systematically addressed. There were bath hoists, and other equipment available in the home that promoted safe working practices. The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 27 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 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 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Lodge DS0000011643.V349811.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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. 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