Inspection on 03/07/07 for Victoria Lodge

This inspection was carried out on 3rd July 2007.

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

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

Other inspections for this house

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Victoria Lodge 26-28 Manor Road Romford Essex RM1 2RA Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 3rd July 2007 10:00 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 Victoria Lodge DS0000069388.V344854.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. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Lodge Address 26-28 Manor Road Romford Essex RM1 2RA 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) 01708 765 757 01708 765 757 Kirkstone Care Ltd Vacant Care Home 17 Category(ies) of Dementia (7), Old age, not falling within any registration, with number other category (17) of places Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code 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 - Code OP (maximum number of places: 17) Dementia - Code DE (maximum number of places: 7) The maximum number of service users who can be accommodated is: 17 2. Date of last inspection Brief Description of the Service: Victoria Lodge offers 24-hour residential care to a total of 17 people over the age of 65 years in the categories of OP, older people not falling within any other category, and DE, dementia care. The maximum number of people with dementia that can be accommodated is 7. The home is a two-house conversion on a corner site in a quiet residential area within the London Borough of Havering. The accommodation is split between 3 floors with two passenger lifts. All rooms are spacious, airy and bright with 15 single rooms and 1 double room. 6 single rooms and 1 double room also have an en suite toilet. All have hand basins, TV points and an emergency call system. There are two lounges, one small and one larger lounge which is integrated with the dining room overlooking the rear garden, with disabled access. There are carparking facilities to the rear of the property for staff and visitors. The home is located close to local services and facilities at Romford Town Centre. The home is easily accessible by public transport or car via the M25, A127 and the A12. The home is operated on the basis of a “family and homely” home environment. The statement of purpose and a copy of the last inspection report were available in the entrance area of the home. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 5 Fee levels at the time of this inspection were £366 - £480 per week. Additional charges are applicable for hairdressing and chiropody. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection this service has changed ownership and, therefore, is viewed by the Commission as a ‘new’ service and previous inspection reports do not apply. This was an unannounced key inspection undertaken by the lead inspector Mrs. Sandra Parnell-Hopkinson. The inspection took place on the 3rd July, 2007 between 10.15 hours and 17.00 hours. The deputy manager and a director of the organisation were available throughout the time to aid the inspection process. At the end of the inspection the inspector was able to provide feedback to the deputy manager and a director of the organisation. During the inspection the inspector was able to talk with many service users, visiting relatives, staff members, the deputy manager, a director of the organisation and a visiting GP. A sample of residents’ files were case tracked, together with the viewing of staff rotas, training schedules, activity programmes, maintenance records, accidents records, fire safety records, menus, complaints and staff recruitment processes and files. The return of an annual quality assurance assessment (AQAA) is still awaited from the organisation. A tour of the premises, including the laundry and the kitchen, was undertaken and all of the rooms were clean with no offensive odours present. A discussion was had with the director and the deputy manager and both were able to demonstrate a good working knowledge and understanding of the various and, sometimes complex, areas relating to equality and diversity. Residents were asked by the inspector how they wished to be referred to in this report, and those residents who were able to respond told the inspector that they wished to be referred to as “residents because that is what we are.” What the service does well: All staff were observed to treat residents with kindness and respect. Residents appeared well dressed and groomed and those spoken to said that they were very pleased with the care that they receive. Relatives spoken to also expressed satisfaction with the service and said that staff were always helpful and cheerful. One relative told the inspector “I am really satisfied, Mum has been here for about 2 years and seems happy.” Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 7 Although there has been a change in the ownership of the home and some staff have left, it was apparent during the inspection that the deputy manager and the staff team have worked extremely hard in covering vacant shifts. This has ensured that generally the service to the residents has been consistent. The deputy manager has a comprehensive working knowledge of the needs of all of the residents, and goes ‘the extra mile’ to make sure that all needs are being met. The food served is of a good standard, and there is a choice of meals for residents. One resident told the inspector “the food is really nice and there is always plenty to eat and drink.” Relatives can have a meal at the home, and one relative told the inspector “I stayed and had lunch with my husband the other week, and it was lovely.” Wherever possible residents are encouraged to retain skills of daily living, and during the inspection a resident was seen to be helping with laying the dining tables. Some residents are encouraged to help staff make and serve drinks during the afternoon/evenings once the main cooking has been completed in the kitchen. The administration of medication is undertaken in accordance with the home’s policy and procedures and the National Minimum Standards for Care Homes for Older People and the appropriate regulations. Staff are appropriately addressing equality and diversity issues, and although the needs of the current residents are those of white British, of a Christian denomination, staff demonstrated a good understanding of other needs such as sexuality and disability. What has improved since the last inspection? What they could do better: Since the change in ownership the previous registered manager has resigned for personal reasons. Until a new manager is appointed it is essential that the Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 8 organisation ensures that the deputy manager is given daily support in the running and administration of the home. Staffing levels must be reviewed as a matter of urgency and this must include both care workers and ancillary staff. The home must have ancillary cover at the weekends and at mealtimes to ensure that the care workers are engaged in caring for, and in maintaining daily living skills for the residents. Care workers should not be engaged in hoovering/cleaning parts of the home at the expense of the care and welfare of residents. Although each resident does have a care plan, these require review so that they contain greater detail to ensure that the correct level of care is being provided to each resident. Risk assessments are in place for some areas of risk, but again these need to be reviewed for each residents. Also daily recordings of events involving residents must be more comprehensive and reflective of the outcomes identified in the care plans. More emphasise must be given to individual and small group activities so that residents remain as active both mentally and physically as is possible. This is also essential for those residents who are now living with varying degrees of dementia accommodated at the home. Information for residents, and policies and procedures must be reviewed so that these are reflective of the new organisation. 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. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 9 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 Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 5 (standard 6 is not applicable to this service) People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Prospective residents and their relatives, have some information needed to enable them to decide if they want to live at Victoria Lodge, and that an assessment of their needs is undertaken before moving in. However, although the statement of purpose and service user guide is made available to all residents and their relatives, these need to be revised to reflect the current facilities, service and numbers. All current residents have a contract stating the terms and conditions of residency at Victoria Lodge, these need to be reviewed to reflect the new organisation. This will mean that any changes must be discussed and agreed with residents and their relatives/representatives. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 11 EVIDENCE: A new resident told the Inspector that she had been given a copy of the statement of purpose and service user guide on admission to the home, and that she had a contract stating the terms and conditions. However, on examining these documents and the files of some residents, it was found that there are several areas that need revising to reflect the new ownership. When reviewing these documents it is important that consideration also be given to producing them in a more simplified format for the benefit of those residents who have short-term memory loss, confusion or who are living with dementia. Wherever possible all prospective residents and their families are encouraged to visit the home prior to admission, but this is often thwarted by the processes implemented by the local funding authority and/or quick discharges from hospital. The Inspector was satisfied that the deputy manager and one of the directors (in the current absence of a registered manager) undertakes an assessment prior to any prospective resident being admitted to the home. This was confirmed by inspecting the file of a recently admitted resident. Both directors with involvement in this service are suitably qualified to undertake such assessments of need. It is essential that assessments of need are comprehensive because this information is used to develop the care plan, and agree outcomes with the resident and/or his/her family/representative. All residents are given a contract stating the terms and conditions of residency at Victoria Lodge. Intermediate care is not provided at Victoria Lodge, and standard 6 is not applicable. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 12 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 and 11 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Although each resident’s health and personal care needs are set out in an individual care plan, these need to be more detailed and comprehensive. However, residents can generally be sure that their health needs will be met and that they will be treated with respect and their right to privacy is upheld. The medication policies and procedures of the home ensure that all residents are protected. EVIDENCE: The files of 5 residents were examined and all had a care plan, which covered various aspects such as personal care needs, health care needs, communication, activities, nutrition and mobility. However, these did not accurately reflect the care being given by staff or the needs of residents, and details of night care should be more comprehensive. For instance does a resident like 1 or 2 pillows, the light on/of or window open/closed. In Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 13 discussions with the deputy manager it was evident that one resident had behavioural problems around the inappropriateness of urinating in public areas, but there was no plan of care in the file. With a detailed plan of care for all residents, where appropriate, such as requiring staff to discretely remind the resident on a regular basis of the need to use the toilet, and in good time to account any slowness in mobility, such accidents may be avoided. Several residents are diabetic and all had reasonable care plans in place. Blood sugar monitoring was being undertaken for 3 residents in accordance with their care plan, and the instructions of the GP or the district nurse. One recently admitted resident is a diabetic, and the hospital has made a referral to the GP for the monitoring of the blood sugars for this person. The deputy manager will be following up this referral to ensure that the GP provides the necessary guidance and instructions. It is necessary that on admission the weight of a resident is recorded, but this was not evidenced on the file of the most recently admitted resident. For some residents it was evident that their weight is being monitored on a monthly basis, but this was not true for all residents. The current weighing equipment used at the home is not suitable for the effective weighing of the current residents, due to their increasing frailty, dementia and mobility. However, records are being maintained of the food intake for residents, and where concerns were noted advice was sought from the GP or the district nurse. The use of risk assessments must be improved and recorded. However, in discussions the inspector was satisfied that the deputy manager and some staff are very well informed of the needs and risks, in certain areas, for some of the residents. This does not just apply to moving and handling but to other aspects of a person’s life. For instance if a resident requires to be transferred from bedroom to lounge/dining room by way of a wheelchair, then a risk assessment must be undertaken to ensure that staff are aware of the need to ensure that the arms of the resident are tucked inside the chair to avoid damage when being pushed through a narrow doorway or corridor, and that footplates are always in place. Other residents may need assistance to prevent falling when standing up from a chair, and it is not sufficient to record “observe”. Some residents have a hearing aid and again there should be a detailed plan of care around such aids. This is to ensure that the hearing aid is always clean, has working batteries and is switched on. This should also apply to any other aids or adaptations used by the residents. Risk assessments should also be recorded for those residents who may wish to help in the kitchen area in the preparation of drinks and snacks, or with washing/drying crockery and cutlery. All care plans are reviewed on a monthly basis with a record being maintained of the date of review, but there was little evidence of the plans being amended due to the changing needs of the residents. However, the deputy manager Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 14 demonstrated a good knowledge and understanding of the current needs of the residents. Daily records should be more detailed and reflective of the needs and outcomes of residents which should be identified in the care plans. Medication administration records (MAR) were inspected and these were all found to be in good, as were the medications. One small area for improvement, which was discussed with the deputy manager during the inspection, is where the prescription states 1 or 2 (or other such instruction) then a record should be maintained of the actual number/amount of medication given at a particular time. The inspector was satisfied that all residents have access to a GP, dentist, optician, chiropodist and any other health professional as necessary and such visits were recorded on the individual files. However, more use should be made of the local continence advisory service. During the inspection a GP was visiting and she told the inspector “the care here is very good, I have no concerns and I am always phoned if the staff are worried.” The GP was visiting in response to a call made during the inspection because the deputy manager was concerned around one of the residents. It was also evident that every endeavour is made to contact family/representatives to keep them informed of any changes. Staff were observed to treat residents with kindness and respect, but there could have been more actual interaction when undertaking care tasks. There was little evidence that end of life had been discussed with either residents or their relatives, and it is acknowledged that this can be a difficult and sensitive area. However, it is an important part of a resident’s care plan and more consideration must be given to this area. End of life care planning is not just about the actual wishes after death, but the desired plan of care leading up to the process of dying and death. Staff may benefit from some training in this area and the registered manager is directed to the guidance currently given by the Department of Health and the Commission for Social Care Inspection, both of which can be found on the respective web sites. In discussions with the deputy manager and the director it was evident that any resident wishing to remain at Victoria Lodge, rather than being transferred to hospital, would be enabled to do so with the appropriate services being provided. This could involve Macmillan or Marie Curie nurses, the GP, and any other professional. Support would also be given to the families, friends and staff. The inspector discussed in great detail with the director the need for comprehensive and detailed care plans and risk assessments, together with the need to review the system of file management. The accident records were also inspected and these were well documented with details of the necessary action taken recorded. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 15 In spite of the need to improve the care plans and other documentation, the inspector was satisfied that the current staff and especially the deputy manager, are very aware of the needs of the residents and that any health and personal care needs are being met. Victoria Lodge DS0000069388.V344854.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 and 15 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Although residents will find the lifestyle experienced in the home matches their expectations, and generally satisfies their social, cultural, religious and recreational interests, this could be improved upon by a review of staffing levels. Residents are encouraged and assisted to maintain contact with family, friends and the local community and are helped to exercise choice and control over their lives. A wholesome appealing balanced diet is provided in congenial surroundings. EVIDENCE: Although the daily living functions at the home are flexible, such as residents being able to get up and go to bed when they wish, and there being some flexibility around meal times, other social and stimulating daily activities have deteriorated because of the ratio of staffing against the increased dependency of residents. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 17 In talking to residents and some relatives it was apparent that external entertainers are still visiting the home. One relative said “the entertainer the other week was excellent, my mum really likes him as she has seen him before and really enjoys it.” However, more consideration must be given to the provision of individual and smaller group activities and those residents with short-term memory loss, or confusion would benefit from shorter individual activities. The development of life histories will help in this area. The deputy manager and the director of the new company, were both aware that daily activities needed more attention, and that these had ‘somewhat fallen by the wayside because of some staff leaving, the increased dependency of the residents, and the disruption because of the change in ownership’. It was evident in discussions with the deputy manager that some of the evening functions organised by staff have declined, and generally this has been because staff have been too busy ‘meeting the basic needs of the residents’ and have not had the time to ‘do the extras’. There are regular visits by local clergy and if any resident wishes to attend a religious service outside of the home then this would be arranged. Other annual festivals are celebrated and these include the birthdays of residents. Books with large print are also available within the small lounge of the home. Some residents still enjoy playing an active part in preparing snacks and light refreshments, in washing up and laying and clearing tables. Residents are enabled to do this and the kitchen area is available during the afternoons with staff supervision. Although there are set mealtimes, residents can exercise choice in relation to these as these are made flexible and varied to suit an individual’s preferences and capacities. Four meals per day are served and these are: • • • • Breakfast – between 8a.m and 10a.m. Lunch – between 12 noon and 1p.m. (or later if desired) Tea – between 5p.m. and 6p.m. (or later if desired) Supper – from about 8p.m. Residents can choose a cooked breakfast, and one resident told the inspector “I like kippers and often have them.” Drinks and snacks are freely available between these times, and during the inspection the inspector observed that coffee had been served at about 10a.m. and then at about 11a.m. a resident came and asked for a cup of tea. The response from the member of staff was “of course you can have another cup, I will just go and make it for you.” Lunch was observed being served, and the meals were nicely presented and served and residents were not being hurried. One resident was quite agitated and kept asking to ‘go home’ and did not want his lunch. The deputy manager asked a member of staff to take him for a walk, which she did. When they returned, the deputy manager was able to persuade the Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 18 resident to have his lunch, and he ate all of it. This was good care practice because it demonstrated the flexibility of the service to meet the changing needs of residents at a particular time. Menus were viewed and these give a choice for residents, but there are also other choices available if neither of the main dishes are liked. Menus have been produced in pictorial format for those residents with short term memory loss or confusion, and these have proved beneficial in assisting such residents make choices. The cook is well aware of the recorded dietary and cultural needs of each resident and does listen to their comments about the meals, and makes adjustments and changes where necessary. There is now more fresh fruit and vegetables available for residents. With the change in ownership there were some alterations to the supplier of food and drinks. This did result in some complaints being made by a few residents and relatives. However, the inspector has been told that these issues were addressed and that there are no more complaints. This was confirmed in discussions with both residents and relatives. One resident told the inspector “the meals are very nice and there is always sufficient, and I can ask for more.” A relative said “my aunt sometimes has a meal with mum and she always says the food is excellent.” She went on to say “the staff are good and they will make me a cup of tea, but if they are busy I can make one for myself in the kitchen.” Some residents have chosen to sit in the lounge area for their meals, and these are served at small tables. Contact with family and friends, and the local community, are encouraged and this was evidenced during the inspection through talking to residents and relatives. One relative told the inspector “I just visit when I want to, and there has never been a problem.” A local youth service visits the home sometimes, and this seems to be beneficial to both the residents and the visiting youth. However, more could be done to involve the residents in the activities of the local community, and hopefully this will evolve with the employment of a new manager. One area of concern is the practice of leaving the small tables in front of residents throughout the day. These can be viewed as restrictions, and can also prove a hazard to other mobile residents and staff if the seated resident pushes the table away unexpectedly. This was discussed with the director who has undertaken to consult with residents in an endeavour to remove as many of these tables as is possible. Currently several of the residents smoke and they sit outside at the rear of the building. Obviously this is acceptable in good weather but not when it is cold Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 19 and raining. Under the new Smoke-free (Exemptions and Vehicles) Regulations 2007 introduced on the 1st July 2007, residential care homes have to provide a room for residents, which is designated as a ‘smoking area’ and be well ventilated. Further information on this can be obtained from the relevant H.M. Government website, and the Commission understands that an information pack has been sent to all residential care homes. It will also be essential for the management to ensure that consideration is given to protecting the health of care staff who are looking after residents who smoke. The Royal College of Nursing (RCN) has produced a helpful booklet “Protecting community staff from exposure to second-hand smoke” and is available on their website www.rcn.org.uk. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 20 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents and their relatives can be confident that their complaints will be listened to and taken seriously and acted upon in their best interests. Residents generally are protected from abuse through the training of staff but robust policies and procedures must be consistently implemented. EVIDENCE: There is a complaints procedure that is clearly written, and available to residents. However, this does now need to be put into a format which can be more easily understood by those residents who have a degree of memory loss, confusion or who may be living with dementia. However, some residents spoken to said “we know who to complain to if we needed to, and that would be the manager.” Complaints are viewed by the management as positive and are used as a means of service development. This was evidenced in discussions with the deputy manager and the director, and in viewing the complaints log. There are two current complaints that are being dealt with by the new management, and many of the issues referred to in these complaints have already been addressed by the management as evidenced during the inspection. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 21 Residents spoken to felt satisfied with the service provision, felt safe and well supported by staff who have their protection and safety as a priority. All staff have undertaken training in safeguarding adults and abuse and this forms part of the induction training for new staff. The promotion of the individual’s rights is central to the aims and objectives of the new owners and advocates are used where necessary to help residents if required. There are no current nor outstanding safeguarding adult issues, but the organisation must ensure that robust recruitment policies and procedures must consistently be implemented and this matter is referred to in more detail under the NMS (National Minimum Standards) Staffing section of this report. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 22 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, 21, 24 and 26 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents live in a safe, well-maintained environment which is clean, pleasant and hygienic. However, areas of the home do not meet the National Minimum Standards on the environment, but the new owners will make every effort to ensure that the rights and safety of all residents remains a priority, with gradual improvements being made where the structure of the building will allow. EVIDENCE: A tour of the premises, both internal and external, was undertaken and the home was generally in a good decorative condition, reasonably well maintained, with no offensive odours. There is now a programme of redecoration, refurbishment and maintenance put into place by the new owners. A new carpet has been ordered for the large lounge and it is to be hoped that this will be laid in the very near future. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 23 15 of the bedrooms are single, 6 of which have an en suite toilet, and there is 1 double room which also has an en suite toilet. All of the bedrooms viewed were clean, airy and spacious, but the new management want to redecorate some of the bedrooms and this will be done in consultation with the residents. There are two communal bathrooms, one of which is fitted with chair hoist for the ease of residents getting into and out of the bath. However, plans are now agreed for the replacement of the bath and the redecoration of this room. The other bathroom has been refurbished and is now a shower room. Bath taps are fitted with temperature control valves which are checked regularly. One resident told the inspector “I like the new shower, and it is nearer to my bedroom.”“ All bathrooms with toilets, communal toilets and en suite toilets inspected had soap, towels and toilet rolls. The deputy manager and staff were very well aware of the need to ensure that the control of infection is well managed throughout the home. Many of the external doors are alarmed and all fire signs where necessary were in place during the inspection. At the present time the office area is very open and it is difficult to hold private/confidential meetings with residents, staff or visitors. Again the construction of a partition wall to form an actual office would add to the facilities of the home, and the new owners will give consideration to this alteration. At the time of the inspection all records were kept secure as was the medication trolley which was locked and secured to the wall. For the benefit of those residents who have varying degrees of short-term memory loss and/or confusion the rear garden has now been made secure so that residents are not in danger of wandering through the side gates into the road, or into the car park. The rear garden is well maintained and has been made secure by the use of shrubs and a low fence. Locks on the garden gates can be unlocked by the input of numbers, known to the staff, and following a recent fire inspection it has been confirmed that this security does not impact on the fire exits. There is now a programme for the installation of suitable equipment to enable the doors to be left open, but will be closed in the event of a fire as the closures are activated by the fire alarm. Because Victoria Lodge is an older care home, originally registered under the 1984 Registered Homes Act (now repealed and replaced by the Care Standards Act 2000), it is exempt from complying with some of the environmental standards contained in the National Minimum Standards for Care Homes for Older People. These are mainly around room sizes and width of doorways and corridors. However, the new owners must make every effort to ensure that Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 24 standards are met wherever the structure of the building will allow. For the ease of those residents who are unable to negotiate stairs, there are two lifts and a ramped access to the smaller lounge. In discussions with several residents they did not express any concern around using the ramp and this did not pose a problem. Necessary aids and adaptations are provided where necessary. The kitchen was clean and well maintained, and food was appropriately stored and labelled. The laundry area was clean and well maintained, and a new industrial washing machine had been purchased and was delivered during this inspection. New fire regulations came into effect on the 1st October 2006 and the previous proprietor commissioned the services of a qualified consultant to undertake a fire risk assessment, and a copy of this report was available at the home during the inspection. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 25 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to the service. Residents can be sure that their needs will be met by the skill mix of staff. However, they should also be sure that they will be supported and protected by the home’s recruitment policy and practices, and that these will be consistently applied. They can be sure that staff are trained and competent to do their jobs. EVIDENCE: Although with the change in ownership some staff have taken the opportunity to leave Victoria Lodge, many of the previous staff team remain at the home and this is providing continuity of care for the residents. The deputy manager remains at the home and has been very effective, together with the majority of the staff team, in providing good care to the residents. However, it was apparent from discussions with the deputy manager and a director of the organisation, and from observations during the inspection, that there must be an urgent review of staffing levels. The new organisation had already identified the need for a review, and plans were in place for the recruitment of an additional member of care staff for the afternoon/evening shifts. However, this staffing review must be wider and encompass the duties that are currently being undertaken by care staff at the expense of care to the residents. This will be a requirement in this report. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 26 More than 50 of the staff have achieved NVQ level 2 and some have achieved NVQ level 3. Staff told the inspector that they had previously received training in moving/handling, safeguarding adults, fire safety, administration of medication, food hygiene and infection control, and this was confirmed when viewing the training schedule. There is a programme already arranged for future training for some of the staff. However, the director told the inspector that both the registered manager and a senior member of staff had walked out of the home without fulfilling a due notice of employment termination. This had made it necessary to recruit a new member of staff, who demonstrated that she had the necessary experience and qualifications, without taking up a new criminal records bureau disclosure (CRB). This member of staff did have a CRB which had been undertaken during the past year by a previous employer. This fact was confirmed when viewing the file of this new member of staff. It was made very clear to the organisation that CRB’s are not portable, and a new CRB must be applied for when a new member of staff is being recruited and, provided the CRB has been applied for, a POVA first check can be applied for which, if clear, will enable the person to commence work – under supervision – pending receipt of the new disclosure. Another contributory factor was that the home was not registered with an umbrella organisation for the application of CRB’s, and that this matter was being dealt with as a matter of urgency to rectify the situation. References had been taken up and an application form completed, together with a criminal declaration signed by the employee. Certificates of qualification had also been seen and photocopies were on file, which included training in the safeguarding of adults. The inspector was able to speak to some of the residents, and all of those spoken to told the inspector that the new member of staff was very nice and kind, and treated them well. The organisation must ensure that all future recruitment is robust and in accordance with the policies and procedures of the company, and that all references and CRB’s are taken up prior to the person actually working at the home. Staff are receiving supervision and this is being recorded. Supervision currently includes 1:1 and group supervision. However, the introduction of direct observation was discussed with the deputy manager and the director, and this aspect of supervision will be introduced in the near future. The introduction of the Mental Capacity Act 2005, with effect from the 1st April, 2007 for those residents who do not have family or friends to act for them, and from the 1st October, 2007 for all other adults was discussed with the director and the deputy manager. Both were aware of this important legislation, and it Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 27 is essential that all staff working at the home receives training in the implications of the implementation of this Act. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 28 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 People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a view to the service. In spite of the absence of a registered manager, residents can be sure that the deputy manager and the organisation are managing the service adequately. The home is being run in the best interests of the residents, staff are being appropriately supervised and the financial interests of residents are safeguarded. The health and safety and welfare of residents and staff could be better promoted and protected with increased staffing levels. EVIDENCE: Currently the home is without a registered manager, but the deputy manager with support from the new organisation is carrying on the service in the best interests of the residents. Residents spoken to said that the deputy manager Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 29 was really nice and worked very hard. One resident told the inspector “no matter what I ask her she is always smiling and kind, she works very hard.” The inspector has been informed that advertisements have been placed for a new manager, but in the interim one of the two directors will be at the home on a daily basis to give support to the deputy manager and the staff team. Both directors have experience of operating another care home, and both are also registered nurses. Although staff have endeavoured to maintain the documentation to a reasonable standard, this has been difficult as the deputy manager had to take on areas of responsibility that where new to her, and this has resulted in some of the record keeping being left. It is essential that arrangements are put into place to ensure that all record keeping at the home is maintained to a good standard at all times. Staff are receiving supervision and this was evidenced during the inspection of records, and also staff meetings are being undertaken. The service does not act as appointee for any of the residents, but does manage small sums of money required by residents for the purchase of toiletries, hairdressing, chiropody, newspapers and such. Records inspected indicated that such records are well maintained with receipts are retained for all items of expenditure. The responsible individual must undertake monthly unannounced visits to the service in accordance with Regulation 26 of the Care Home Regulations 2001, and a copy of these reports must be sent to the Commission for the next 6 months, on a monthly basis. Maintenance records including the fire risk assessment, fire drills, fire alarm testing weekly from a different point, lift and other moving/handling equipment, gas, electrics and water were inspected and these were found to be in good order. A visit from the local environmental health officer had been undertaken in 2006, and there were no requirements from that visit. Insurance limits were in accordance with requirements and these were £10 million employer’s liability and £5 million public liability. Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 30 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 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 3 X 3 Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 31 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 OP1 Regulation 6 Requirement The registered provider must review the statement of purpose and the service user guide, and ensure that these are produced in various formats to suit the needs of the residents. With updated information in formats which they can use, prospective residents will be able to make a better informed choice of whether they wish to live at Victoria Lodge. The registered provider must ensure that all residents have an up to date contract or statement of terms and conditions which are reflective of the new organisation. This should ensure that residents have correct information on fee levels, increases and termination clauses, together with details of the new owners of the home.. The registered provider must ensure that all residents have a comprehensive and up to date care plan which reflects current needs including night care and end of life plans. Also that any risk is identified and has an DS0000069388.V344854.R01.S.doc Timescale for action 31/10/07 2 OP2 5 31/10/07 3 OP7 15 30/09/07 Victoria Lodge Version 5.2 Page 32 4 OP8 12(1)(a) 13(4)(c) 5 OP12 OP13 16 (2)(m)(n) 6 OP18 OP28 OP29 19 7 OP19 12(1)(a) 8 OP27 18(1)(a) appropriate risk assessment in place. This will ensure that all of the needs of residents are met in a safe manner whilst maintaining independence of the individual wherever possible. The registered provider must ensure that the home has effective equipment to weigh residents, that weights are monitored to ensure that any increases/decreases are addressed. This will ensure the continued health and welfare of the residents. The registered provider must consult residents about their social interests and make arrangements to enable them to engage in local, social and community activities, and also to consult and provide a programme of activities arranged by the care home, and provide facilities for activities in relation to recreation and fitness. This is particularly important for residents living with dementia or other cognitive impairments or other disabilities. The registered provider must ensure that robust recruitment procedures are consistently applied when employing new members of staff. It is essential that residents are protected from possible abuse and bad care practices through the implementation of all safe practices at the home. The registered provider must ensure compliance with Smokefree (Exemptions and Vehicles) Regulations 2007 which were introduced on the 01/07/07. This is to ensure the health and welfare of residents and staff The registered provider must DS0000069388.V344854.R01.S.doc 31/07/07 30/09/07 13/07/07 31/07/07 31/07/07 Page 33 Victoria Lodge Version 5.2 9 OP31 8 10 OP30 18(1)©(i) review all staffing levels to ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. This will ensure that all residents at the home are enabled to experience an improved quality of life. The registered provider must appoint an individual to manage the care home, and advise the Commission of the name of the person appointed and the date on which the appointment is to take effect. This will ensure that the care home is run and managed effectively on a day to day basis. The registered provider must ensure that all staff working at the home undertake training in the implementation and implications of the Mental Capacity Act 2005. This will ensure that all care delivered at the home is in accordance with the wishes of each resident who has capacity to give such instructions and choices, and arrangements made for those residents who do not have capacity and who do not have family or a representative to act for them. 31/10/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000069388.V344854.R01.S.doc Version 5.2 Page 34 Victoria Lodge Standard Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Victoria Lodge DS0000069388.V344854.R01.S.doc Version 5.2 Page 36 - 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. 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