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Inspection on 26/01/06 for The Lodge Walton

Also see our care home review for The Lodge Walton for more information

This inspection was carried out on 26th January 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

In this period the proprietor has worked effectively with the Commission and professionals from Social Services and Health to address the concerns raised. This has included carrying out an internal investigation of the issues and addressing them through staff disciplinary action, instigating training programmes, renewing equipment and addressing the ethos of the home. There had been sufficient evidence of improvement through an action plan to address the allegations of abusive practice in the home for the strategy meetings to conclude, with ongoing progress continuing to be monitored by the Commission. The inspector had been impressed by the positive attitude and approach of the proprietor and the staff to dealing with a difficult and emotional situation and the way in which they sought to reduce the impact on the service user group.

What has improved since the last inspection?

The manager has introduced a number of initiatives to address the shortfalls in documentation, such as care planning, risk assessments and policy and procedures. The work on these had only just started at the time of the inspection, but if these initiatives are completed they should form a good standard on which to base the day-to-day delivery of the service. The atmosphere and appearance of the home has improved, and service users in particular appeared more stimulated and well.

What the care home could do better:

The work commenced at the point of the inspection must be developed and issues such as care plans and risk assessments completed. In addition the recruitment procedures must be robust which sufficient information gathered to support this. New staff must be properly inducted and the ongoing development of staff must be consistently addressed.

CARE HOMES FOR OLDER PEOPLE The Lodge - Walton 82 Kirby Road Walton On Naze Essex CO14 8RJ Lead Inspector Sara Naylor-Wild Unannounced Inspection 26th January 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Lodge - Walton Address 82 Kirby Road Walton On Naze Essex CO14 8RJ 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) 01255 850809 N/A Mr Ramesh Chandra Chopra Mrs Renuka Rani Chopra, Mr Rajeev Chopra Manager post vacant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21), Physical disability (2) of places The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 21 persons) Two persons, under the age of 65 years, who require care by reason of a physical disability, whose names were made known to the Commission in May 2003 The total number of service users accommodated must not exceed 21 persons 31st August 2005 Date of last inspection Brief Description of the Service: The Lodge is located in a residential area on the outskirts of Walton-on-theNaze. The property is a two-storey brick building with a tiled roof, with car parking space at the front, and attractive gardens to the rear. The house is on a local bus route, and has easy access to the town. The home provides 24hour personal care and support, and has a through-floor lift and other equipment (e.g. mobile hoist, hand rails, etc) to assist service users with limited mobility. The Lodge is registered to provide residential care to 21 Older People (i.e. over the age of 65). The home currently accommodates two service users who are under the age of 65, and this information is reflected in the home’s registration certificate. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 26th January 2006, and the Manager designate was present throughout the visit. During the inspection the inspector sampled documents such as care plans, staff files, toured the building and spoke with service users. At the previous inspection of 31st August 2005, the inspector had raised serious concerns regarding the practice of named staff in both their actions and ethos operating in the home. This had led to a Protection of Vulnerable Adults referral and the home became the subject of strategy meetings led by the Social Services Older Peoples team. Identified actions were required of the registered persons in order to address these concerns. During this time the inspector carried out additional visits to the home in order to monitor their progress in addressing these serious concerns. The findings from these visits are included in the content of this report. What the service does well: What has improved since the last inspection? The manager has introduced a number of initiatives to address the shortfalls in documentation, such as care planning, risk assessments and policy and procedures. The work on these had only just started at the time of the inspection, but if these initiatives are completed they should form a good standard on which to base the day-to-day delivery of the service. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 6 The atmosphere and appearance of the home has improved, and service users in particular appeared more stimulated and well. 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 - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, 5 and 6. The home assesses service users’ needs prior to their admission, and these provide a basis to dertmine whether the home can meet the service users’ needs. The home supports prospective service users and their families visiting prior to admission. The home does not provide intermediate care. EVIDENCE: The manager has instigated a new assessment format and has begun introducing this documentation for new admissions. The documents provide opportunity to collate suitable levels of information to understand the needs of service users referred. However the value of these lies predominantly in the quality of the content and this is an area that should be developed further. The documents would inform the suitability of the home in meeting the service user’s needs prior to an admission. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 9 Documentation such as the Statement of Purpose refer to the home’s policy of inviting prospective service users to visit the home prior to admission. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 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 the following standard(s): 7 and 9. Updated care planning documents provide a better basis for understanding how service users’ needs should be met. The medication policy supports good practice, further training for staff is required. EVIDENCE: The manager has introduced a new format for assessment and care planning. This has a greater emphasis on a person centred approach and gives detail to staff in how to support service users’ assessed needs. Some statements sampled should be further developed, however this provides a good basis from which to develop the documents and staff’s practice in working to care plans. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 11 An updated medication policy and a copy of the Royal Pharmacutical Society medicines guidance had been introduced by the manager. A review of practice identified that there were still some omissions in recording on a regular basis. This had been identified by the manager as a shortfall, and discussed with the inspector how this issue would be addressed. Included in this was a revisit of all staff medication training to ensure a competency based medication training package was undertaken. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed. EVIDENCE: The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. The home’s Protection of Vulnerable Adults (POVA) policy was in place. EVIDENCE: As part of her review and update of all policies and procedures the manager had introduced a new POVA policy. This was a comprehensive statement of what constitutes abuse and how staff should react to reports of abuse. The whistle blowing policy supported the POVA policy in its direction to staff in the respect of poor practice. Both documents formed part of the staff induction programme and the manager planned to introduce POVA training into the staff development programme for the coming year. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19. The environment had been updated and was clean and brightly presented. EVIDENCE: Since the last inspection visit the proprietor had installed a new nursecall system, updated furnishings and equipment, decorated rooms and laid new flooring in corridors and service users’ bedrooms. This had contributed to a much improved presentation of the home and gave a sense of commitment to the maintenance of the premises. One assisted bath had broken down and been reported to the manager, who reported that the proprietors had already agreed to order a replacement and this would be delivered in 4-6 weeks. As this had reduced the available baths to one for 21 service users, which is well below the requirements of the NMS and Care Homes Regulations 2001, it is of vital importance that this work is carried out. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29. Documentation required on staff files were not complete. EVIDENCE: The sample of staff files seen during inspection indicated that there were still staff files that did not contain all the items listed in Regulation 19, Schedule 2 of the Care Homes Regulations 2001. Whilst this was not a further shortfall as new staff had not been recruited since the previous inspection, the manager was reminded that all staff working at the home were required to submit the documentaty evidence listed. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 36. The new manager’s practice had impacted on the day to day operations of the home. Staff supervision planning had commenced. EVIDENCE: The manager had implemented a number of initiatives since commencing her post from updating policies to ensuring all areas of the home were tidy and free from clutter. This attention to all aspects of how the home operates demonstrates a good holistic management perspective, which will benefit the service and those who use it. The manager had instigated a supervision programme for all staff and was commencing the sessions with individual appraisals. The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 17 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 2 X X The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? YES 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 OP4OP7OP 8OP37 Regulation 15 Requirement The registered person must ensure that care plans contain sufficient detail to instruct staff in how to meet the identified needs of service users, and that these are regularly reviewed and updated. This is a repeat requirement. The registered person must ensure that the staffing levels are subjected to regular review against the assessed needs of service users. This standard was not assessed at this visit and will be reviewed at the next inspection. The registered person must ensure that staff are only employed following rigorous recruitment checks including two written references, CRB checks and inclusion on the POVA list. This is a repeat requirement. The registered person shall ensure persons employed in the home receive appropriate training to the work they perform, and that a planned programme of development is DS0000018013.V280839.R01.S.doc Timescale for action 31/03/06 2 OP27 18 31/03/06 3 OP29 18,19, Schedule 2 31/03/06 4 OP4OP30 18 31/03/06 The Lodge - Walton Version 5.1 Page 19 5 OP3OP7OP 38 13(4)(5) 6 OP36 18(2),21 7 OP37 17,12,13, Schedules 1,2,3, 4 8 OP8 12,13,14, 15 9 OP12OP14 12(2)(3) (5),16 arranged. This standard was not assessed at this visit and will be reviewed at the next inspection. It is required that risk assessments are carried out on all safe working practices and activities and that action is instigated which complies with current health and safety guidance. Specifically this relates to the moving and handling assessments. This is a repeat requirement. The registered person must ensure that staff receive regular line management supervision. This is a repeat requirement. The registered person must ensure that records required by Regulation are maintained. This standard was not assessed at this visit and will be reviewed at the next inspection. the regisrestered person must ensure that service users’ health needs are monitored and action required to meet these included in care planning. This is a repeat requirement. The registered person must ensure that service users are provided with opportunities to exercise choice and control in their daily lives, including recreational, spiritual and social needs. This standard was not assessed at this visit and will be reviewed at the next inspection. The registered person must ensure that specialist equipment is provided to meet service users’ assessed needs. This standard was not assessed at this visit and will be reviewed at the next inspection. DS0000018013.V280839.R01.S.doc 31/03/06 31/03/06 31/03/06 31/03/06 31/03/06 10 OP22 23,2(n) 31/03/06 The Lodge - Walton Version 5.1 Page 20 11 OP19 23 (j) The registered person must ensure that sufficient bathing facilities are available to meet service users’ assessed needs. 31/03/06 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 OP28 Good Practice Recommendations The home needs to ensure they are on target to meet the requirement for a minimum of 50 of care staff to hold a NVQ level 2 by 2005. This standard was not assessed at this visit and will be reviewed at the next inspection. The registered manager needs to hold a NVQ level 4 in management by 2005. This standard was not assessed at this visit and will be reviewed at the next inspection. The registered person must keep under review the provision of assisted baths in relation to service users’ assessed needs. This standard was not assessed at this visit and will be reviewed at the next inspection. 2 OP31 3 OP21 The Lodge - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 - Walton DS0000018013.V280839.R01.S.doc Version 5.1 Page 22 - 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!