CARE HOMES FOR OLDER PEOPLE
Trent Lodge 6-8 Essex Road Enfield Middlesex EN2 6TZ Lead Inspector
Tony Brennan Key Unannounced Inspection 16th August 2007 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Trent Lodge DS0000010693.V343425.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. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Trent Lodge Address 6-8 Essex Road Enfield Middlesex EN2 6TZ 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) 020 8367 2159 020 8364 5328 Dr Sirjit Singh Seyan Mr Jashvant Babulal Kotecha Mrs Janet Tracey Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16) of places Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th November 2006 Brief Description of the Service: Trent Lodge is part of an organisation that has a number of homes. Trent Lodge is a care home registered for sixteen service users who are over the age of 65. The home is well established and is near the centre of Enfield Town. The home has twelve single rooms and two double rooms. None of the rooms have en suite facilities. The home has a stair lift. The home is situated near one of the entrances to Enfield Town Park. It is easily accessed by car and public transport and within walking distance of the town centre. The home benefits from a large garden at the rear of the house. The garden is well maintained and a pleasant place for service users to sit. The home provides care for service users of either sex who are older and in need of personal care only. The fees are between £406 and £450 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection was undertaken as part of the annual inspection programme. I sought to confirm that the areas for improvement identified at the last Random inspection were addressed. The inspection took place over one day. Janet Tracey, registered Manager assisted me with the inspection. I received comment cards from people who use the service, relatives and professionals. I spoke with three people who live at Trent Lodge, two relatives and three members of staff. I observed care practice and interaction between people living at the home and staff. I toured the building and examined a number of records relating to the care, health and safety and management of the home. I would like to thank Janet Tracey and all the staff who assisted me by answering questions about the running of the home. I would also like to thank the three people who live at the home who discussed their views of the service they receive and all those individuals who returned comment cards. What the service does well:
A person who had recently come to live at the home said, “ I came and had a look round before deciding to come here to live.” I found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The statement of purpose clearly identified that the home supports people with dementia. It explained the range of needs that will be met by the home. One of the people case tracked had recently come to live at the home. There was a detailed assessment of the persons needs by care management. As part of the assessment process, information on the persons needs had been obtained from social care and health professionals. The person told me that she had been able to discuss with the registered manager how she wished to be care for. Diary notes showed that the people case tracked had access to their general practitioner when necessary. Diary notes also confirmed that where the general practitioner had recommended specific medical interventions these were followed up and put in place. One of the general practitioners commented Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 6 that staff were, “ always able to give information regarding a resident’s symptoms.” The records of medicines received, administered and returned to the pharmacist were all complete. I found that the medication for each of the people case tracked was accurately recorded. Training has recently been provided on the safe administration of medicines. I spoke with staff and found they were clear about their responsibilities and how to handle medicines safely. The menu showed that options are offered at each meal. People who live at the home were generally pleased with the quality of the food provided. A person who lives at the home said, “ the food is good”. People told me that they understood how to make a complaint. They also felt that any complaints they raised would be dealt with in a sensitive manner. Since the last inspection there had been one adult protection allegation. This was found, after investigation, not to be proven. The registered persons cooperated fully and openly with the investigation process. I walked round the home and found that it is appropriately decorated and furnished. All bedrooms have been decorated. Bedrooms were personalised with items of furniture and pictures belonging to people who live at the home. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff have received training on infection control measures. I observed that staff were able to effectively meet the needs of people living at home. People living at the home told me that staff are available to meet their needs. I observed that staff were available at key times of the day (e.g. mealtimes) to assist people. I examined two staff files and found that these contained all the required information relating to their recruitment. The registered manager has extensive experience of working with older people and those with dementia. The registered manager explained that she has just completed a National vocational qualification at level 4 in care and management. The registered manager was able to show me that she has introduced effective systems to ensure that people living at the home received the care that they need. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 7 Fire drills were taking place and the fire alarm was tested regularly. The system had been regularly checked. I found that the fire risk assessment included an assessment of all the potential fire risks in the home. I questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. What has improved since the last inspection?
All areas for improvement identified at the last key inspection were found to have been met. The initial assessments also provided information on the person’s life history. I found that since the last key inspection detailed life histories are being developed in consultation with people who live at home and their relatives. These were used to identify the personal preferences and interests of people. I found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. Since the last inspection the registered manager now ensures that more detailed information is available on the needs of people living in the home. Care plans now identified the care and support required by people with diabetes. Two of the people case tracked has diabetes and care plans showed that the insulin had been reviewed by the GP. The information available on the needs of people living at the home has significantly improved since the last inspection. The needs of people are identified and met. Detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. Since the last inspection tissue viability assessments have been put in place. One of the people case tracked had been identified in both his initial assessment and his care plan as having a risk of developing pressure sores. A referral had been made to the district nurses and the necessary treatment had been provided. I spoke with one of the district nurses who confirmed that the home had provided information on the level of risk and followed an agreed treatment plan for this person. Since the last inspection more activities have been planned and provided by the home. I spoke with people who live at the home who told me that they are provided with regular activities. Diary notes referred to individual’s participation in the various activities provided at the home. I observed that activities were taking place at various times throughout the day. For example, in the afternoon there was a sing-along. I found that since the last inspection all the fire extinguishers had been checked and were in working order. The registered manager explained that a number of faulty fire extinguishers had been replaced.
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 8 Bedroom doors are now kept closed. The people who have expressed a wish to have their bedroom door left open have had an automatic closure device fitted. The registered manager explained that since the last inspection two members of staff had commenced working at the home. I examined their files and found there was a record of an appropriate induction to working at the home. I spoke with both members of staff who were able to explain to me the needs of people living at home and their role in supporting them. They also confirmed that they had the relevant induction training. Training records and certificates showed that since the last inspection staff had received training in all the statutory required areas and dementia care. Five staff have completed an in-depth course on dementia care. The registered manager explained that she is planning to arrange for further staff to attend this course. I spoke with staff that confirmed that they had this training. They understood the dementia care needs of one of the people case tracked. Staff now receive regular supervision so that they can effectively meet the needs of people living at the home. I spoke with staff who told me that they had received supervision. They felt that this had been useful and enabled them to meet the needs of people more effectively. I saw that there were records of supervision sessions that had been held with staff. These had covered issues relating to the care of people living at the home and the development of the individual staff members. The registered manager was able to show me records to confirm that she has begun to appraise staff. What they could do better:
Four areas for improvement were identified as part of this inspection. Discussions with the registered manager and my case tracking of three people living at the home showed that the current format of care plans needs to be reviewed so that information is easily accessible on the needs of people. This was discussed with the registered manager and it is recommended that a review of the current care planning format be undertaken. The home’s pharmacist had recently reviewed the homes medication handling procedures and found that these were generally safe. The pharmacist had made a number of recommendations. I discussed these with the registered manager who was able to provide evidence that they had been addressed. There was a recommendation that photographs of individuals be put with these medication packs to aid identification. This had not been addressed. I
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 9 discussed this with the registered manager and recommended that this be addressed to ensure the safety of people living at the home. The registered manager was able to show me that four staff have the National Vocational Qualification at level two and two more staff were doing the same qualification at level 3. There are 13 care staff in total. The home still needs to achieve 50 of staff with the National vocational qualification at level 2 in care. The registered manager explained that more care staff would be starting the qualification soon to make sure this target is met. Staff will then have the skills to support people effectively. Training records showed that all staff had been on adult protection training. However, Essex council provided this training. Staff had not been on Enfield adult protection training. This issue had been highlighted in the recent adult protection meeting. Staff must be trained in Enfield procedures for adult protection to ensure that people living at home are protected. 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. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 10 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 Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 11 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): 13 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose is an accurate description of the service provided. People’s needs are assessed prior to admission to the home to ensure they receive the care and support they require. EVIDENCE: Comment cards from people who live at home and relatives confirmed that Trent Lodge provided sufficient information about the service that is provided. People had also visited the home before they were admitted. A person who had recently come to live at the home said, “ I came and had a look round before deciding to come here to live.” Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 12 I found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The statement of purpose clearly identified that the home supports people with dementia. It explained the range of needs that will be met by the home. The statement of purpose also identified the skills and staffing resources that are to be available to meet the needs of people living at home. The statement of purpose contained a positive statement on the promotion and support for people to express their diversity. I discussed equalities and diversity issues with registered manager who demonstrated that she would respond positively to people with these needs. Comment cards from relatives and professionals confirmed that Trent Lodge was able to meet the different needs of people. One of the people case tracked had recently come to live at the home. There was a detailed assessment of the persons needs by care management. As part of the assessment process, information on the persons needs had been obtained from social care and health professionals. The person told me that she had been able to discuss with the registered manager how she wished to be cared for. I found that this was reflected in the person’s care plan. Two relatives also confirmed that they had been involved in the initial assessment process to determine how their relative’s needs could best be met. The initial assessments for the people case tracked identified their specific personal and medical needs. The initial assessments also provided information on the person’s life history. I found that since the last key inspection detailed life histories and being developed in consultation with people who live at home and their relatives. These identified the cultural and religious beliefs of people. These were used to identify the personal preferences and interests of people. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 13 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 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are fully planned for. People who use the service are fully protected by safe procedures for handling medication. People’s right to privacy is supported. EVIDENCE: I found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. Since the last inspection the registered manager now ensures that more detailed information is available on the needs of people living in the home. Comment cards received from people who live at the home and relatives were generally positive about the way peoples needs were met. A health professional commented, “residents always appear well cared for and happy.”
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 14 Care plans now identified the care and support required by people with diabetes. Two of the people case tracked have diabetes and care plans showed that the insulin had been reviewed by the GP. In one case the person had a poor diet. She had been referred to the dietician and the plan of care had been developed. Diary notes showed that her diet had recently improved. The registered manager explained that all care plans had been reviewed in consultation with people who live at home or their representatives. In this way it had been possible to ensure that there was detailed information on how they were to be met. The information available on the needs of people living at the home has significantly improved since the last inspection. Discussions with the registered manager and my case tracking of three people living at the home showed that the current format of care plans needs to be reviewed so that information is easily accessible on the needs of people. This was discussed with the registered manager and it is recommended that a review of the current care planning format be undertaken. Care plans were personalised and referred to the cultural needs of people. This included whether or not they wish to take part in religious practices. There was also information on peoples’ interests and previous occupations. People I spoke to told me that they felt staff understood the needs. A person who lives there said, “I like it here at Trent Lodge. Staff understand what I want and like.” I observed that staff took time to understand people and do things in the way they had been asked. A General Practitioner commented that people’s right privacy and dignity were always respected. He observed and said that, “I never need remind staff to take residents to their rooms. The door is closed during consultations.” Detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. Since the last inspection tissue viability assessments have been put in place. One of the people case tracked had been identified in both his initial assessment and his care plan as having a risk of developing pressure sores. A referral had been made to the district nurses and the necessary treatment had been provided. I spoke with one of the district nurses who confirmed that the home had provided information on the level of risk and followed an agreed treatment plan for this person. Nutritional assessments had been put in place since the last inspection. These recorded the level of risk and dietary needs of the people case tracked. The weight of people case tracked was monitored regularly. Where necessary the referrals have been made to the dietician for advice and support. Any changes were noted in their care plan and nutritional risk assessment. Diary notes showed that the people case tracked had access to their general practitioner when necessary. Diary notes also confirmed that where the general practitioner had recommended specific medical interventions these
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 15 were followed up and put in place. One of the general practitioners commented that staff were, “ always able to give information regarding residents’ symptoms.” The records of medicines received, administered and returned to the pharmacist were all complete. Medicines were stored safely. All medicines are stored at the appropriate temperature. Controlled drugs for two people are currently held in the home. The record was in place to show that these medications are administered safely. I found that the medication for each of the people case tracked was accurately recorded. The home’s pharmacist had recently reviewed the homes medication handling procedures and found that these were general safe. The pharmacist had made a number of recommendations. I discussed these with the registered manager who was able to provide evidence that they had been addressed. There was a recommendation that photographs of individuals be put with these medication packs to add identification. This had not been addressed. I discussed this with the registered manager and recommended that this be addressed to ensure the safety of people living at the home. Changes to medication have been recorded. The general practitioner had signed the changes on the medication administration chart. Medicines held for the people case tracked corresponded with the changes made by the general practitioner. Training recently has been provided on the safe administration of medicines. I spoke with staff and found they were clear about their responsibilities and how to handle medicines safely. Training records also contained certificates confirming that this training had taken place. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 16 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 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. People living at the home are able to make choices about how they live in the home. The menu reflects the preferences of people living at the home and offers a balanced diet. EVIDENCE: Since the last inspection more activities have been planned and provided by the home. I spoke with people who live at the home who told me that they are provided with regular activities. Diary notes referred to individual’s participation in the various activities provided at the home. I observed that activities were taking place at various times throughout the day. For example, in the afternoon there was a sing-along. People spoken to told me that they
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 17 enjoyed the activities provided by the home. The registered manager explained that she had reviewed the activities programme to ensure that a range of activities was available and that they met the needs of people with dementia. I observed that staff spend time talking with people who live at the home and listening to what they had to say. Peoples’ interests were recorded as part of their care plans. A relative spoken to told me that there were no restrictions on visiting the home. People who live in the home told me that they could see visitors in private if they wish to. Diary notes showed that people living at the home had regular contacts with family, friends and the wider community. The menu showed that options are offered at each meal. People who live at the home were generally pleased with the quality of the food provided. A person who lives at the home said, “ the food is good”. Another person commented about the choice of food offered and that staff had “asked about what food I like”. There was specific guidance on individual plans where they had dietary needs. I saw that meals were well presented and they were provided in a relaxed manner. Sufficient staff were available, and when necessary, people were being assisted to eat. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 18 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 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service.People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures protect people from abuse. EVIDENCE: People told me that they understood how to make a complaint. They also felt that any complaints they raised would be dealt with in a sensitive manner. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. There had been a number of minor complaints since the last inspection. Action had been taken to address these complaints. If the complaint highlighted a need for improvement in care practice this had been addressed. For example, one relative had complained their items of clothing had gone missing or were damaged when being clean. This had been investigated and staff meeting minutes showed that the issue had been raised with staff. The relative had been reimbursed for the cost of the loss or damage clothing. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 19 Since the last inspection there had been one adult protection allegation. This was found,after investigation, not to be proven. The registered manager and provider cooperated fully and openly with the investigation process and had taken on board any recommendations for improvement in care practice. There were comprehensive policies on handling abuse and protection. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 20 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 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment. The home is clean and hygienic. EVIDENCE: I walked round the home and found that it is appropriately decorated and furnished. There is a passenger lift providing access for people who live at the home. The home also had been adapted to meet the needs of people living there. This included the provision of raised toilet seats, bath hoists and handrails. All bedrooms have been decorated. Bedrooms were personalised with items of furniture and pictures belonging to people who live at the home.
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 21 I found that since the last inspection all the fire extinguishers checked and work in working order. The registered manager explained that a number of faulty fire extinguishers had been replaced. Bedroom doors are now kept closed. The people who have expressed a wish to have their bedroom door left open have had an automatic closure device fitted. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 22 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 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available at all times to meet the needs of people who live at the home. Staff do not have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: I observed that staff were able to effectively meet the needs of people living at home. People living at the home told me that staff are available to meet their needs. The rota showed that a consistent level of staffing is maintained on each floor. I observed that staff were available at key times of the day (e.g. mealtimes) to assist people. Staff were also observed to spend time with people both individually and in small groups. This allowed more attention to the individual needs of people who live at the home.
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 23 The registered manager explained that since the last inspection two members of staff had commenced working at the home. I examined their files and found there was a record of an appropriate induction to working at the home. I spoke with both members of staff who were able to explain to me the needs of people living at home and their role in supporting them. They also confirmed that they had the relevant induction training. Training records and certificates showed that since the last inspection staff had received training in all the statutory required areas and dementia care. Five staff have completed an in-depth course on dementia care. The registered manager explained that she is planning to arrange for further staff to attend this course. I spoke with staff who confirmed that they had this training. They understood the dementia care needs of one of the people case tracked. Training records showed that all staff had been on adult protection training. However, Essex council provided this training. Staff had not been on Enfield adult protection training. This issue had been highlighted in the recent adult protection meeting. Staff must be trained in Enfield procedures for adult protection to ensure that people living at home are protected. The registered manager explained that further training was planned. A training plan was in place. This showed that training is planned to ensure that staff continue to be able to effectively meet the needs of people. The registered manager was able to show me that four staff have the National Vocational Qualification at level two, and two more staff were doing the same qualification at level 3. There are 13 care staff in total. The home still needs to achieve 50 of staff with the National vocational qualification at level 2 in care. The registered manager explained that more care staff would be starting the qualification soon to make sure this target is met. Staff will then have the skills to support people effectively. I examined two staff files and found that these contained all the required information relating to their recruitment. I found that there were no unexplained gaps in the employment history of recently recruited staff. A health check has been carried out to ensure that staff coming to work at the home could safely meet the needs of people. Trent Lodge DS0000010693.V343425.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 36 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home are consulted about the quality of the service provided and encouraged to make suggestions for improvement. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: The registered manager has extensive experience of working with older people and those with dementia. The registered manager explained that she has just
Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 25 completed a National vocational qualification at level 4 in care and management. The registered manager was able to show me that she has introduced effective systems to ensure that people living at the home received the care that they need. She is working closely with the deputy manager to ensure that staff are supported to deliver the best possible outcomes for people living at the home. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals was in place. Staff meetings are taking place to ensure staff are aware of plans to develop the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. I randomly checked these records and found that money had been signed for and receipts obtained. People are safeguarded by the homes financial procedures. Staff now receive regular supervision so that they can effectively meet the needs of people living at the home. I spoke with staff who told me that they had received supervision. They felt that this had been useful and enabled them to meet the needs of people more effectively. I saw that there were records of supervision sessions that had been held with staff. These had covered issues relating to the care of people living at the home and the development of the individual staff members. The registered manager was able to show me records to confirm that she has begun to appraise staff. Fire drills were taking place and the fire alarm was tested regularly. The system had been regularly checked. I found that the fire risk assessment included an assessment of all the potential fire risks in the home. I questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. I discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to ensure the safety of people who live at the home. The temperature of food delivered to and cooked was recorded. The temperatures of the fridges and freezers were recorded and within safe limits. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 26 Trent Lodge DS0000010693.V343425.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 3 X 3 X X x 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 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Trent Lodge DS0000010693.V343425.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. 1. Standard OP30 Regulation 18(1)(a) Requirement The registered persons must ensure that all staff have been trained in Adult protection covering Enfields Adult protection procedures. Staff must be trained in Enfield procedures for adult protection to ensure that people living at home are protected. Timescale for action 28/11/07 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 OP7 Good Practice Recommendations The registered persons should update the care plan format so that it can incorporate all the information on peoples needs. This will make sure that it is easy to locate all the information needed to meet people’s needs. The registered persons should make sure that staff can
DS0000010693.V343425.R01.S.doc Version 5.2 Page 29 2 OP9 Trent Lodge 3 OP28 identify who they should administer medicines. This could be done by placing a photograph of the person with their medication packs. This needs to be addressed ensure the safety of people living at the home. The responsible person should ensure that 50 of staff achieves NVQ at level 2 in care. Staff will then have the skills to support people effectively. Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Trent Lodge DS0000010693.V343425.R01.S.doc Version 5.2 Page 31 - 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!
