Inspection on 26/09/06 for The Lodge Walton

This inspection was carried out on 26th September 2006.

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

Other inspections for this house

The Lodge Walton 18/12/08

The Lodge Walton 19/06/07

The Lodge Walton 26/01/06

The Lodge Walton 31/08/05

The Lodge Walton 27/01/05

The Lodge Walton 10/08/04

The Lodge Walton 11/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Lodge - Walton 82 Kirby Road Walton On Naze Essex CO14 8RJ Lead Inspector Jenny Elliott Key Unannounced Inspection 26th September 2006 09:00 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 - Walton DS0000018013.V313917.R02.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 - Walton DS0000018013.V313917.R02.S.doc Version 5.2 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 Application in progress 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.V313917.R02.S.doc Version 5.2 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 26th January 2006 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 homes registration certificate. The home also accommodates a number of service users who have developed dementia since living in the home. The home charges service users between £375 and £475 per week. This information was contained in the home’s records seen on the day of the inspection. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information supplied to the Commission since the last inspection (26th January 2006) including questionnaires returned by service users and relatives. A site visit was made to the home on 26th September 2006 where time was spent with people living at the home, staff and the manager in addition to the inspection of records held by the home. It also includes information from the provider gathered at a meeting following the visit to the home. People living at the home have a range of mobility, physical and emotional needs. A significant number of standards were not met at this inspection, however there were plans in place to address some of these in the near future. What the service does well: What has improved since the last inspection? There were sufficient and appropriate bathing facilities at the home to meet the varied needs of service users. Staffing levels had been maintained to ensure that the basic needs of people living at the home could be met. Risk assessments were in place in respect of the mobility levels of people living at the home. Record keeping in the home had improved. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 6 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.V313917.R02.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 - Walton DS0000018013.V313917.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessments undertaken by the home did not provide sufficient information. Information for prospective service users was not wholly complete or current. EVIDENCE: The assessment paperwork used by the home is in the form of a checklist, identifying areas where support is needed. There was space on the form for the assessor to add information to inform judgements about abilities, but this information was not routinely provided. This meant that the form did not contain sufficient information from which a full care plan, related to the particular needs and aspirations of each person, could be produced. The service did not provide intermediate care, but did provide respite care. Assessments for service users receiving respite care were usually, but not The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 9 always updated prior to each visit. A recent experience at the home had highlighted for the manager, the need to undertake comprehensive assessments that are updated before every visit. A well-presented package of information is available for people interested in the home. In the copies available in the home some of the information provided is out of date or inaccurate. Updated copies were provided at the meeting held after the site visit. The Commission was advised that these are held at the company’s head office for ease of distribution to potential residents and their families. The Lodge - Walton DS0000018013.V313917.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans did not address all of the service users needs, or meet their aspirations. EVIDENCE: Three plans of care were inspected during the visit to the home. All three were laid out similarly and contained the same pro-forma’s suggesting that these were in common use. In some areas it was noted that there was clear guidance for staff about the particular needs and wishes of the individual service user. Although, much of the care plan consisted of generalised instructions to ‘enable’, ‘assist’ or ‘encourage’ service users. This means that any particular wishes about how a person wants to be helped, or information about particular likes and dislikes were not included. The assessment and care plan package in operation at the home includes a number of templates to assess risk levels, e.g. associated with falling. Two of the records inspected belonged to service users who were identified as being at ‘high risk’ of falling. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 11 There were no associated risk management strategies to minimise this risk without unduly restricting the individual’s independence. Bedsides were being used for one service user, but there was no current risk assessment associated with their use in place. There were clear reviews of care plans. Some of these included information to support changes to care plans or the continuation of existing care plans. There were other areas of the care plan that required updating because people required additional help, for example at mealtimes, and this had not been incorporated into the original care plan or the review of the care plan. The plans inspected included details of visits by health professionals, and there was a pre-prepared information sheet for each service user providing good information should admission to hospital be necessary. There are a number of people living at the home who have developed dementia, and others who can become quite confused at times. Where it was in place the assessment and monitoring of people’s mental health was basic. Daily logs were compiled for each person at the end of each shift. Again there were a few occasions when the quality of information was such that it could be used to support the care plan, but much of the information was of a very general nature, e.g. ‘good diet’, ‘pleasant morning spent in lounge’. The administration, storage and recording of administration of medication were inspected or observed. Medication was administered in a way that maintained the independence of people living at the home. There were no gaps identified in the administration records. In the interaction observed between staff and service users, dignity was promoted, people were treated with respect and kindness. There were a number of signs around the home (and particularly in the downstairs bathroom) that were instructions to staff. This gives an institutional feel and detracts from the sense of the service being the home of service users. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not meet the social or recreational needs of service users. People living at the home are able to make choices about the basic routines of the day. Mealtimes were pleasant, but not all meals were sufficiently nutritious or wholesome. EVIDENCE: The manager was aware that improvement was required in this area. There was an advertised list of daily activities on one of the notice boards, but no evidence that they took place. Questionnaires received from service users and relatives highlighted this as a poor area in terms of the service provided at the home. People living at the home have a range of cognitive abilities, and therefore capacity for social activity. The timetable of events displayed on the notice board did not demonstrate that this had been taken into account. The interaction between service users and staff observed at lunchtime was friendly and appropriate. Some of the people living at the home spent the majority of the rest of the day walking around the home, with almost no interaction with The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 13 anyone. One person asked repeatedly where they were and why they were there. Whilst the anxiety was dealt with in a patient and kindly way, no other interaction was observed initiated by staff. Another service user, who was waiting to be helped downstairs for the afternoon, said staff ‘were very kind, but they had a lot to do’. They also said they ‘didn’t like being on their own too long and enjoyed sitting in the lounge’. It was known that another person disliked noise, but the home had not identified how their need for social stimulation could be met. Relatives reported that they could visit at any time and felt the home was welcoming. The financial records of service users personal allowance were inspected. Cash balances matched the records held by the home, and receipts were in place to evidence expenditure. Although the dining room was also being used as a lounge on the day of the inspection (due to decorating of the lounge), it was homely and not too cramped. Service users spoke highly of the food at the home. Two different meals were served for lunch on the day and both were well presented. The lunchtime was unhurried, and the atmosphere congenial. Menus for other days of the week included chicken nuggets and hot dog and onions. At the meeting held with the provider following the site visit the Commission was advised that the advice of a nutritionist had been sought in respect of the meals provided. Daily logs provided evidence of drinks and sandwiches being provided at night if requested by service users. Two service users needed help with their meals. A member of staff sat next to one person whilst they helped them with their lunch. Another person was helped by a member of staff who stood over them, this did not help to promote the dignity of the service user. One person was observed being helped with a meal that had been liquidised. All the elements of the food had been liquidised together so there was no differentiation of texture, colour or taste. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. The home responds appropriately to complaints. The home has not taken sufficient steps to protect service users from abuse. EVIDENCE: The home had received a complaint since the last inspection that was addressed by a multi-disciplinary team, including representatives from social services and health. A second complaint had been investigated by the home. A copy of the home’s response to the complaint they investigated was not available, so it was not possible to assess the quality of that investigation. The complaints and their outcomes were discussed with the manager. The manager identified that the home needed to improve its assessment procedures, risk management strategies, records in respect of food and liquid intake and medical interventions. There was no evidence available at the site visit that staff had completed training in respect of protecting vulnerable people from abuse. At a subsequent meeting with the owner of the home the Commission was advised that all staff had undertaken this training in 2005 and that further training had been booked for january 2007. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was clean, pleasant and hygienic. The home did not take sufficient steps to ensure the home was safe. EVIDENCE: A tour of the premises was undertaken as part of the site visit. The home was clean throughout, and people completing questionnaires said that this was always or usually the case. The property was well maintained and the lounge had been recently decorated. There was a homely feel throughout the premises. The fire officer had identified the need to change a lock to a bedroom door, that formed part of a fire escape route, but this had not been done. The home’s fire risk assessment did not address the shortfall. The owner of the home advised that they had followed this up with the fire authority and an alternative way of managing the situation had been agreed. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 16 However the manager was not aware of this resolution at the time of the inspection. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff did not have sufficient skills and training to fully care for the people living at the home. The home’s recruitment practices were adequate. EVIDENCE: There were eight vacancies for service users at the time of the visit to the home. Of the 13 service users living at the home the manager said that four people had dementia (although not all had a full diagnosis), and several others were ‘confused’. Full details of staff training at the home, or details of forthcoming training were not available on the day of the site visit. Records relating to two members of staff were inspected. The manager acknowledged that there were gaps in basic training including fire safety and moving and handling as well as training to meet the specific needs of service users such as caring for people with dementia. The manager advised that much of this had been planned. The home did not have copies of the General Social Care Council’s Code of Conduct, which must be supplied to all staff. Both of the files belonging to staff that were sampled included completed application forms, two references, Criminal Records Bureau (CRB) checks and proof of identity, this level of vetting helps to protect service users. There was The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 18 no evidence however, that gaps in employment had been explored to identify any reasons that would question a persons’ suitability to care for vulnerable people. The Lodge - Walton DS0000018013.V313917.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager was clear about her responsibilities and understood the strengths and weaknesses within the home. The manager did not have all information necessary in respect of the day-to-day management of the home. The home did not sufficiently incorporate the wishes of service users into future development plans. There was a good level of financial investment in the fabric of the building and in staff training planned. The supervision and trainng levels of staff was inadequate. The service’s Fire Safety arrangements were not adequate. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 20 EVIDENCE: The manager has completed a registered managers award and has many years experience in care. The manager reported a good relationship with the provider who supported the developments she wanted to undertake within the home. It was evident at the meeting between the owner of the service and the Commission that the manager of the service was unaware of some of the actions taken by the owner. This was particularly in respect of issues related to health and safety and maintenance. Whilst it is recognised that the owner took on these roles to support the manager, it is important that the person left in day to day charge of the home has sufficient information at all times. The home did not have a comprehensive quality assurance programme in place. The home had sent questionnaires to service users and relatives in the past, but did not incorporate other forms of feedback, e.g. complaints or any internal assessment of the quality of the service provided into a monitoring system that could be used to inform future developments. The home had engaged the services of a consultant who had carried out an audit of the home against a range of areas. The audit did include corrective action required to be taken by thehom where gaps were identified. The financial procedures of the home were not inspected. The home did have vacancies, but the manager advised that the provider was meeting with the local authority to discuss referrals. There was nothing identified at the inspection to suggest that the vacancies were impacting on investment or dayto-day expenditure within the home. Records in respect of service users money were clear and accurate. Staff were not being formally supervised, the manager identified this as an area that required addressing as a priority. The manager advised that staff meetings were held (approximately bi-monthly). Notes of those meetings were not seen. There were gaps in basic training, although some of these had been arranged in the next few months. A fire risk assessment had been produced, but as stated earlier it did not include action agreed with the fire authority. The Lodge - Walton DS0000018013.V313917.R02.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 2 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 X 2 The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 22 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 OP1 Regulation 4,5 Requirement The registered person must ensure that the Statement of Purpose and Service User Guide kept at the home are up to date and accurate about the services provided. The registered person must ensure that a full assessment of need is made before any service user moves into the home, and that this assessment is updated regularly. The registered person must continue to develop care plans to ensure they contain sufficient detail to instruct staff in how to meet the identified needs of service users, and that these are regularly reviewed and updated. Timescale for action 31/12/06 2 OP3 14 31/12/06 3. OP7 OP8 15 31/12/06 4. OP10 OP15 12(4)(a) 5. OP12 OP14 12,16 The registered person must ensure that the home is conducted in a manner which respects the privacy and dignity of service users. The registered person must provide facilities and services to DS0000018013.V313917.R02.S.doc 31/10/06 31/12/06 The Lodge - Walton Version 5.2 Page 23 6. OP18 OP27 OP28 OP30 OP33 13(6), 18 7. 24 8. OP36 18(2),21 9 OP38 OP19 23(4) service users in accordance with the statement required by Regulation 4(1)(b). The registered person must ensure that at all times suitably qualified, competent and experienced persons are working in the care home. The registered person must develop the systems in place for reviewing the quality of care available at the home. The registered person must ensure that persons working at the home are appropriately supervised. Previous timescale of 31/03/06 not met. The registered person must take adequate precautions against the risk of fire. 31/12/06 31/01/07 30/11/06 30/11/06 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 OP29 Good Practice Recommendations The registered person should record explanations provided by potential staff at interview of gaps in their employment history. The Lodge - Walton DS0000018013.V313917.R02.S.doc Version 5.2 Page 24 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.V313917.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!