Inspection on 31/07/08 for Tudor Lodge

This inspection was carried out on 31st July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tudor Lodge 19/09/06

Tudor Lodge 12/12/05

Tudor Lodge 14/06/05

Tudor Lodge 01/02/05

Tudor Lodge 15/06/04

Similar services:

Springfield House

The Shelley

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Tudor Lodge 18-20 Manor Road Folkestone Kent CT20 2SA Lead Inspector Mrs Penny McMullan Unannounced Inspection 31st July 2008 09:30 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 Tudor Lodge DS0000059434.V367773.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. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tudor Lodge Address 18-20 Manor Road Folkestone Kent CT20 2SA 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) 01303 251195 F/P 01303 251195 tudorlodge@1stchoicecarehomes.com Mr Kanagaratnam Rajaseelan Mr Kanagaratnam Rajamenon Mrs Julie Williams Care Home 44 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. 3. Dementia (DE) - maximum number of places 21. The maximum number of service users to be accommodated is 44. Service users with dementia-type illnesses to be accommodated in ground floor and first floor rooms only. 19th September 2006 Date of last inspection Brief Description of the Service: Tudor Lodge is a residential care home providing care and support for up to forty-four older people, which may include people with dementia. The home is owned by 1st Choice Care Homes. The registered manager of the home is Mrs Julie Williams. She holds the NVQ IV in Management and Care and the Registered Manager’s Award. The home is situated near to Leas Cliff and is convenient for the town centre of Folkestone. There is a small front garden and a well-maintained and flat rear garden. There are parking facilities to the rear of the home. Accommodation is provided on four floors and there is a shaft lift and stair lifts that connect each floor. There are three lounges and a large dining room that is on two levels. The home has forty-one bedrooms, thirty-five of which have ensuite facilities. It is within level walking distance of the bus and railway stations. The fees for this home range between £320 and £450. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that the people who use the service experience good quality outcomes. This key inspection was carried out over a period of time and concluded with an unannounced visit to the home between 10.00am and 6.00pm. Residents and staff were spoken to. Observations included interactions between residents and staff. Surveys were sent to the home to distribute to residents, staff and professionals. Feedback from the people who use the service, and relatives, staff and Care Managers is positive. Various records were viewed during the inspection and there was a partial tour of the home, including the communal areas and some bedrooms. The home is now registered to provide dementia services, however at the time of the inspection no admissions had been made. What the service does well: Resident comments: ‘The staff are helpful and kind’. ‘There are no improvements necessary, not really, I am happy here’. Relative comments: ‘There is always enough staff on duty and the staff are brilliant, there always keep me informed’. ‘ The home is extremely clean and tidy’. When asked what the home does well a relative stated ‘they look after mum’s health and general well being’. Care Manager comments: ‘The home responds quickly and positively and are always helpful to any issues and seek to sort out problems’. ‘They feedback and communicate clients’ needs to the Care Managers’. Staff comments: ‘There is regular training and updates on various subjects. Good communication throughout the care staff regarding service users issues’. ‘The service works very well at the present time’. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People moving into the home can be confident their needs will be met. Arrangements are in place to provide intermediate care to enable residents to be supported to return home. EVIDENCE: The Registered Manager carries out a care needs assessment prior to admission to the home and residents confirm that process did take place. This information forms part of the care plan and there is evidence of care plans from the placing authority. Residents are able to visit the home before deciding to live there. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 9 Resident comment: ‘I have been here a couple of years and I was made very welcome. The Registered Manager visited me in hospital to talk to me about what I needed before I decided to come’ The home has the facilities to provide intermediate care and rehabilitation. This enables residents to be supported to regain their independence before moving back home. At the start of the inspection the home did not have anyone receiving this particular service. Two residents were however being admitted later in the day, therefore this standard could not be fully assessed. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care, which a resident receives, is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Improvements need to be taken to ensure that the home’s medication procedures fully protect the health care needs of residents. EVIDENCE: The care plans cover all aspects of individual’s health and social care. The home is in the process of introducing a new format. Improvements are required when reviews are completed to ensure that any changes are fully recorded. The carers are involved in writing the plans and would benefit from receiving person centre care planning. In some areas the plans have not been fully completed and although carers demonstrate their knowledge of the Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 11 residents this is not fully reflected in the plans. The plans need to clarify what ‘assistance’ means to an individuals personal care records. This is even more essential for residents with dementia or short-term memory loss. Some risk assessments also show ‘assistance’ with one carer. This needs to be clarified to ensure that a safe practice of work is recorded. A requirement will not be made in this report as the home is taking action to address these shortfalls, however a recommendation to ensure these are completed will be given. Health care appointments, including GP and District Nurse visits, are recorded and if required those by the Community Psychiatric Nurse. The plans monitor all health care needs, including personal care, weight, skin integrity, behaviours and nutrition. Residents spoken to all say the GP is called promptly and they are well supported with their health care needs. A relative commented: ‘I am always invited to the reviews with my relative present and then in private if there are any other issues to discuss’. Medication is mainly supplied by the monitored dosage system and a medication trolley is used when administering the medication. The Registered Manager ensures that audits are carried out and staff are aware of the importance in reporting any gaps that may occur. However there was evidence that two lots of medication had been dispensed and left in the medication trolley although the carer was able to recognise one of the pills. When checking the medical administration sheet it was also found that the number of pills administered and recorded were not accurate. The Registered Manager has instigated a full enquiry. The investigation may result in a safeguarding referral, disciplinary action for staff and additional medication training. All of the staff currently administering the medication have received medication training. As the Registered Manager has taken appropriate action a requirement will not be made in this report. The Commission will receive notification of the outcome of this incident. Risk assessments are required to be completed for those residents who are able to self medicate and also when a resident does not wish to take their medication immediately after it has been administered. Residents spoken to at the time of the inspection, and those surveyed, feel the staff respect their privacy and dignity. Residents confirm that the staff always knock the door before entering their room and are polite and courteous. A relative commented: ‘When my relative had a very sensitive problem it was very difficult and the staff handled this in a kind and caring way, respecting her privacy and dignity.’ Tudor Lodge DS0000059434.V367773.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents are able to join in with the activities of their choice to enhance their daily lives. Residents are supported and encouraged to have control over their own routines and lifestyles. Residents receive a well-balanced healthy diet to meet their tastes and choices. EVIDENCE: An activities co-ordinator comes to the home on two afternoons each week. The home plans to increase the activities over five days of the week in the near future. Some of the residents are able to visit the local shops and on occasions staff accompany residents for short walks. The home is planning to have a bbq and on occasions evening entertainment is provided. A church Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 13 representative visits the home. Each resident has an activity profile to identify indivdual insterests. At the time of the inspection one resident was playing the piano and does this each day. Resident comments: ‘I can still manage to go out to the local supermarket and chemist’. ‘Sometimes we have an evenings entertainment and they let people do more or less what they want to do here’. Visitors are made welcome in the home and residents say they can see them in private if they wish. Relatives are offered refreshments and made welcome. Resident’s say they can do what they wish in the home. Discussion was held with one resident who preferred to stay in her room by choice but did go down to the lounge or dining room when she wanted to. All of the residents spoken to in the lounge gave examples of choice with regard to getting up and going to bed, daily life decisions and the activities. Resident comments: ‘ ‘I have a glass of wine with my friend when she comes down from her room upstairs, it is very pleasant.’ ‘I usually go to bed around 11.30 pm’. ‘There are choices for all meals, and do have the choice of a cooked tea. I also have breakfast in bed’. ‘This place is fine, I like the food it is usually good’. ‘My room is nice and I have brought my own bits and pieces’. Tudor Lodge DS0000059434.V367773.R01.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. 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. Residents are confident that their complaints will be listened to and acted on. Arrangements are in place to ensure that residents are protected from abuse. EVIDENCE: The home has a complaint’s log in place and residents spoken to all say they have no complaints but would know who to speak to and what to do if they had any concerns. The complaint’s procedure is on display and there is also a comments box in the entrance to the home. Resident comments: ‘I have no complaints but I would mention things if I needed to’. ‘If things go wrong it is how you make them right that matters’. Policies and procedures are in place to ensure that residents are protected from abuse. The majority of staff have received protection of vulnerable adult training however the home needs to ensure that all staff receive this training. Tudor Lodge DS0000059434.V367773.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is comfortable, well maintained and in good decorative order, ensuring that residents live in a pleasant, clean and homely environment. EVIDENCE: The home continues to improve the environment and when a bedroom becomes vacant complete redecoration is carried out. One room has just been stripped of plaster and completely rewired and refurbished. The ceiling in the dining room has been replaced and in the near future a complete new kitchen is being installed. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 16 The home is clean and tidy with a pleasant smell throughout. Staff have received infection control training and cleaning schedules are in place. There are satisfactory laundry facilities and the handy person is in the process of carrying out the recommendations made in the recent fire risk assessment. Tudor Lodge DS0000059434.V367773.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are receiving care from a trained and experienced team of staff. Arrangements are in place to ensure that residents are receiving care from staff that have been appropriately vetted. EVIDENCE: At the time of the inspection there were sufficient staff on duty to meet residents’ needs. The Registered Manager stated that they do not currently have any high dependency needs, and they have not started to admit residents who have dementia. Staff say that staffing levels have improved and they now feel there are enough staff on duty. Feedback from residents and relatives all confirm there is enough staff on duty. Staff files examined confirm that there are sound recruitment practices in place to ensure that residents are receiving care from appropriately vetted staff. Some of the documents from established long standing members of staff are not in place and it is recommended that an audit of staff files be completed to establish any shortfalls. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 18 Over fifty per cent of staff have completed NVQ 2 or above and there is an ongoing training programme. There are shortfalls in the updating of first aid awareness and updates in moving and handling are required. Further dementia training is being provided in August. As the Registered Manager is aware of the shortfalls in the training programme a recommendation will be given in this report to ensure that this training and all mandatory training will be provided. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well managed home which is run in their best interests. Arrangements are in place to ensure the people who use the service have their financial interests protected. Improvements in the supervision programme are required to ensure that all staff receive supervision. Residents and staff are protected by the arrangements in place to minimise risk and promote health and safety. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 20 EVIDENCE: Residents and staff are complimentary about the management team. The Registered Manager is qualified and experienced. She has worked in the home for several years and has an effective staff team. The atmosphere in the home is open and inclusive and residents were friendly, relaxed and responsive to questions and discussions. A quality assurance programme is in place and this includes questionnaires being sent to residents, relatives, and other stakeholders. These are due to go out in September. The home needs to ensure that the results are summarised and available to the people to receive feedback on the findings. The home has residents’ meetings and the Area Manager carries out monthly visits to the home to monitor the service being provided. From speaking to the residents it is evident that they feel confident they can speak to the manager and staff about the services being provided. There are some residents who are able to manage their own finances. Other residents are supported with their finances by the home, their relatives or solicitor. There are secure facilities and effective recording systems in place to ensure that all transactions are recorded. This means that residents can feel confident their finances are well taken care of. The Registered Manager has started some supervision for staff and two members of staff confirmed this situation. The programme of supervision needs to be improved to ensure that all staff receive one to one supervision. The Registered Manager says that the Team Leaders will be providing supervision to the carers and will receive the appropriate training to do so. As the supervision programme is in place and ongoing a requirement will not be made in this report. The previous staff meeting was held in April. The AQAA states that all equipment has been serviced and maintenance and safety checks are up to date. Some mandatory training requires updating and the home needs to ensure that this is ongoing. The fire book is in good order and risk assessments are in place. There is clear evidence of staff on duty when fire drills are carried out. There are systems in place to ensure the home complies with health and safety regulations to ensure that residents and staff live in a safe environment. Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 x 3 Tudor Lodge DS0000059434.V367773.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations To ensure that care plans and risk assessments provide detailed information for individuals when providing personal care and ‘assistance’ is clarified To accurately record medication booked on to and administered in the Medical Administration Sheets To ensure that risk assessments are in place for residents who may wish to have their medication left by the carer after administration and for those who self medicate eye drops To update first aid training and continue with on going training programme to ensure that all staff receive mandatory training and protection of vulnerable adult training To ensure that formal one to one supervision is provided for all staff. 3. OP30 4. 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